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Key success factors for thoracic endovascular aortic repair for non-acute Stanford type B aortic dissection.
Eur J Cardiothorac Surg 2014; 46(3):432-7; discussion 437EJ

Abstract

OBJECTIVES

We aimed to determine the key factors associated with successful early and late outcomes after thoracic endovascular aortic repair (TEVAR) for non-acute Stanford type B aortic dissection at our institution.

METHODS

Inpatient and outpatient records were retrospectively reviewed. Patients operated on within 14 days after the onset of acute aortic dissection and those with rupture or malperfusion were excluded.

RESULTS

Forty-five patients (mean age, 55.5 ± 13.1 years; 23-79 years) underwent 53 TEVAR operations for non-acute Stanford type B aortic dissection between 1998 and 2012. Thirty-four patients had a patent false lumen and 19 had an ulcer-like projection (ULP). No early mortality was observed. At late follow-up (7.5 ± 3.9 years) of the 45 patients, survival after the initial TEVAR was 100, 86 and 63%; freedom from aortic reintervention was 87, 73 and 59%; and freedom from open aortic surgery was 89, 84 and 73%, at 1, 5 and 10 years, respectively. Of 15 late deaths, 2 were due to aortic rupture and 2 were operative deaths associated with aortic surgery. Of the 34 patients with patent false lumens before TEVAR, 25 had their descending false lumens thrombosed; of these 25, 16 had remodelling of the descending aorta; and of these 16, 4 had complete obliteration of the false lumen of the entire aorta. By bivariate analysis, the site of the primary entry and age were significantly associated with thrombosis of the descending false lumen, maximum aortic diameter was associated with remodelling of the descending aorta, and absence of abdominal branches arising from the false lumen was associated with complete obliteration of the false lumen of the entire aorta.

CONCLUSIONS

The early results of TEVAR for non-acute Stanford type B aortic dissection were favourable. However, for cases with patent false lumens, complete obliteration of the false lumen of the entire aorta was difficult to achieve. Absence of the primary entry at the outer curvature of the distal aortic arch, younger age, small aortic diameter and absence of the abdominal aortic branches arising from the false lumen were the key success factors.

Authors+Show Affiliations

Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan funcorogash@hotmail.com.Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.Department of Health Policy and Technology Assessment, National Institute of Public Health, Wako, Saitama, Japan.Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

24554070

Citation

Kitamura, Tadashi, et al. "Key Success Factors for Thoracic Endovascular Aortic Repair for Non-acute Stanford Type B Aortic Dissection." European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery, vol. 46, no. 3, 2014, pp. 432-7; discussion 437.
Kitamura T, Torii S, Oka N, et al. Key success factors for thoracic endovascular aortic repair for non-acute Stanford type B aortic dissection. Eur J Cardiothorac Surg. 2014;46(3):432-7; discussion 437.
Kitamura, T., Torii, S., Oka, N., Horai, T., Nakashima, K., Itatani, K., ... Miyaji, K. (2014). Key success factors for thoracic endovascular aortic repair for non-acute Stanford type B aortic dissection. European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery, 46(3), pp. 432-7; discussion 437. doi:10.1093/ejcts/ezu012.
Kitamura T, et al. Key Success Factors for Thoracic Endovascular Aortic Repair for Non-acute Stanford Type B Aortic Dissection. Eur J Cardiothorac Surg. 2014;46(3):432-7; discussion 437. PubMed PMID: 24554070.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Key success factors for thoracic endovascular aortic repair for non-acute Stanford type B aortic dissection. AU - Kitamura,Tadashi, AU - Torii,Shinzo, AU - Oka,Norihiko, AU - Horai,Tetsuya, AU - Nakashima,Kouki, AU - Itatani,Keiichi, AU - Koyama,Sachi, AU - Hari,Yosuke, AU - Araki,Haruna, AU - Sato,Hajime, AU - Miyaji,Kagami, Y1 - 2014/02/19/ PY - 2014/2/21/entrez PY - 2014/2/21/pubmed PY - 2015/5/12/medline KW - Aortic remodelling KW - Chronic type B aortic dissection KW - Thoracic endovascular aortic repair SP - 432-7; discussion 437 JF - European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery JO - Eur J Cardiothorac Surg VL - 46 IS - 3 N2 - OBJECTIVES: We aimed to determine the key factors associated with successful early and late outcomes after thoracic endovascular aortic repair (TEVAR) for non-acute Stanford type B aortic dissection at our institution. METHODS: Inpatient and outpatient records were retrospectively reviewed. Patients operated on within 14 days after the onset of acute aortic dissection and those with rupture or malperfusion were excluded. RESULTS: Forty-five patients (mean age, 55.5 ± 13.1 years; 23-79 years) underwent 53 TEVAR operations for non-acute Stanford type B aortic dissection between 1998 and 2012. Thirty-four patients had a patent false lumen and 19 had an ulcer-like projection (ULP). No early mortality was observed. At late follow-up (7.5 ± 3.9 years) of the 45 patients, survival after the initial TEVAR was 100, 86 and 63%; freedom from aortic reintervention was 87, 73 and 59%; and freedom from open aortic surgery was 89, 84 and 73%, at 1, 5 and 10 years, respectively. Of 15 late deaths, 2 were due to aortic rupture and 2 were operative deaths associated with aortic surgery. Of the 34 patients with patent false lumens before TEVAR, 25 had their descending false lumens thrombosed; of these 25, 16 had remodelling of the descending aorta; and of these 16, 4 had complete obliteration of the false lumen of the entire aorta. By bivariate analysis, the site of the primary entry and age were significantly associated with thrombosis of the descending false lumen, maximum aortic diameter was associated with remodelling of the descending aorta, and absence of abdominal branches arising from the false lumen was associated with complete obliteration of the false lumen of the entire aorta. CONCLUSIONS: The early results of TEVAR for non-acute Stanford type B aortic dissection were favourable. However, for cases with patent false lumens, complete obliteration of the false lumen of the entire aorta was difficult to achieve. Absence of the primary entry at the outer curvature of the distal aortic arch, younger age, small aortic diameter and absence of the abdominal aortic branches arising from the false lumen were the key success factors. SN - 1873-734X UR - https://www.unboundmedicine.com/medline/citation/24554070/Key_success_factors_for_thoracic_endovascular_aortic_repair_for_non_acute_Stanford_type_B_aortic_dissection_ L2 - https://academic.oup.com/ejcts/article-lookup/doi/10.1093/ejcts/ezu012 DB - PRIME DP - Unbound Medicine ER -