Thoracic endovascular aortic repair with stent grafts alone or with a composite device design in patients with acute type B aortic dissection in the setting of malperfusion

Sobocinski, Jonathan; Dias, Nuno; Hongku, Kiattisak; Lombardi, Joseph V.; Zhou, Qing; Saunders, Alan T.; Resch, Timothy; Haulon, Stéphan

doi:10.1016/j.jvs.2019.04.478

Cited by 19 publications

(11 citation statements)

References 20 publications

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“…TEVAR can expeditiously control a rupture or cover the primary entry tear to restore true lumen flow, resulting in reduced ischemic time and improvement of outcomes over medical management alone or combined with open surgery. [31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48] Collectively, accrued data demonstrate improved outcomes with TEVAR for complicated TBAD compared with open surgery or medical therapy alone. Consequently, TEVAR has become the first-line treatment for complicated TBAD.…”

Section: Pathophysiology Of Tbadmentioning

confidence: 99%

The Society of Thoracic Surgeons/American Association for Thoracic Surgery clinical practice guidelines on the management of type B aortic dissection

MacGillivray

Gleason

Patel

et al. 2022

The Journal of Thoracic and Cardiovascular Surgery

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Section: Pathophysiology Of Tbadmentioning

confidence: 99%

The Society of Thoracic Surgeons/American Association for Thoracic Surgery clinical practice guidelines on the management of type B aortic dissection

MacGillivray

Gleason

Patel

et al. 2022

The Journal of Thoracic and Cardiovascular Surgery

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“…Seven retrospective studies, 9–11 , 16–19 with a total of 958 patients enrolled ultimately in our reviews through excluded 1767 duplicates, 4194 irrelevant records, 504 records during data extraction due to not eligible inclusion criteria, and 1 conference abstract 20 due to not available for full text, as shown in the study flow diagram (Figure 1). Table 1 is the summary characteristics of the enrolled studies.…”

Section: Resultsmentioning

confidence: 99%

Distal bare metal stent implantation during thoracic endovascular aortic repair is beneficial to treat complicated type B aortic dissection: A systematic review and meta-analysis

Kong

et al. 2020

Vascular

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Objective To explore whether thoracic endovascular aortic repair (TEVAR) plus distal bare metal stent (BMS) implantation leads to favorable clinical outcomes compared with standard TEVAR in treating acute complicated type B aortic dissection. Methods Relevant publications were found through a precise search of PubMed, Cochrane Library, and EMBASE. Count data were calculated as the odd ratio (OR)and 95% confidence interval (CI) using the Mantel–Haenszel statistical method, quantitative data were calculated as mean difference and 95% CI using Inverse Variance statistical method. When the data heterogeneity was large, with an I2 > 50%, a random-effects model and sensitivity analysis were performed. The analysis tool we used was the software Revman 5.3 and G*power 3.1. Results There were 7 publications involving 958 patients who were enrolled ultimately. The incidence of unplanned secondary intervention and postoperative adverse events in the TEVAR + BMS were lower than standard TEVAR (OR, 0.42, (95% CI, 0.23 to 0.75); OR, 0.57, (95% CI, 0.37 to 0.90)), and the pooled number needed to treat was 15 for unplanned secondary intervention and 15 for postoperative adverse events. There were no significant difference in the aortic-related or all-cause 30-day mortality (OR, 0.81, (95% CI, 0.25 to 2.61); OR, 0.47, (95% CI, 0.18 to 1.22)), aortic-related, all-cause mortality at least 6 months or incidence of the postoperative endoleak (OR, 0.47, (95% CI, 0.17 to 1.32); OR, 0.42, (95% CI, 0.17 to 1.06); OR, 0.81, (95% CI, 0.32 to 2.05)). Conclusion There is no significant outcome difference except for reduced reintervention but this does not seem to adversely affect survival. It is unclear whether this justifies the additional cost of placing it in every complicated type B aortic dissection regardless of anatomy after standard TEVAR alone. Besides, more data are needed to verify the adjunctive distal bare metal stents’ performance at different dissection stages.

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“…This predictive model may be helpful in determining treatment strategies. Selective branched stent-graft combined or not with flap fenestration [3,6,19,20] or use of the composite device (proximal stent grafts and distal bare aortic stent) [21] might be a optimal choice for those susceptiable to organ malperfusion to maximize the organ perfusion restoration. Cerebrospinal-fluid (CSF) drainage, in addition to medical theraphy, for reduction of CSF pressure was recommended for prevention and treatment of spinal cord injury as part of conservative approach or bridge to surgery [22].…”

Section: Discussionmentioning

confidence: 99%

Prognostic dynamic nomogram integrated with metabolic acidosis for in-hospital mortality and organ malperfusion in acute type B aortic dissection patients undergoing thoracic endovascular aortic repair

Liu

et al. 2021

BMC Cardiovasc Disord

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Background Organ malperfusion is a lethal complication in acute type B aortic dissection (ATBAD). The aim of present study is to develop a nomogram integrated with metabolic acidosis to predict in-hospital mortality and organ malperfusion in patients with ATBAD undergoing thoracic endovascular aortic repair (TEVAR). Methods The nomogram was derived from a retrospectively study of 286 ATBAD patients who underwent TEVAR from 2010 to 2017 at a single medical center. Model performance was evaluated from discrimination and calibration capacities, as well as clinical effectiveness. The results were validated using a prospective study on 77 patients from 2018 to 2019 at the same center. Results In the multivariate analysis of the derivation cohort, the independent predictors of in-hospital mortality and organ malperfusion identified were base excess, maximum aortic diameter ≥ 5.5 cm, renal dysfunction, D-dimer level ≥ 5.44 μg/mL and albumin amount ≤ 30 g/L. The penalized model was internally validated by bootstrapping and showed excellent discriminatory (bias-corrected c-statistic, 0.85) and calibration capacities (Hosmer–Lemeshow P value, 0.471; Brier Score, 0.072; Calibration intercept, − 0.02; Slope, 0.98). After being applied to the external validation cohort, the model yielded a c-statistic of 0.86 and Brier Score of 0.097. The model had high negative predictive values (0.93–0.94) and moderate positive predictive values (0.60–0.71) for in-hospital mortality and organ malperfusion in both cohorts. Conclusions A predictive nomogram combined with base excess has been established that can be used to identify high risk ATBAD patients of developing in-hospital mortality or organ malperfusion when undergoing TEVAR.

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Thoracic endovascular aortic repair with stent grafts alone or with a composite device design in patients with acute type B aortic dissection in the setting of malperfusion

Cited by 19 publications

References 20 publications

The Society of Thoracic Surgeons/American Association for Thoracic Surgery clinical practice guidelines on the management of type B aortic dissection

The Society of Thoracic Surgeons/American Association for Thoracic Surgery clinical practice guidelines on the management of type B aortic dissection

Distal bare metal stent implantation during thoracic endovascular aortic repair is beneficial to treat complicated type B aortic dissection: A systematic review and meta-analysis

Prognostic dynamic nomogram integrated with metabolic acidosis for in-hospital mortality and organ malperfusion in acute type B aortic dissection patients undergoing thoracic endovascular aortic repair

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