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Concomitant antegrade stent grafting of the descending thoracic aorta during transverse hemiarch reconstruction for acute DeBakey I aortic dissection repair improves aortic remodeling.
J Card Surg 2017; 32(9):581-592JC

Abstract

BACKGROUND AND AIM

Concomitant endovascular stent grafting of the descending thoracic aorta during open repair for acute DeBakey I aortic dissection can be performed in patients with extensive dissection and malperfusion. We analyzed the effects of this strategy on distal aortic remodeling.

METHODS

From 2006-2014, acute DeBakey I dissection patients without primary aortic arch tear undergoing open distal hemiarch reconstruction (Standard group) versus those undergoing hemiarch with descending thoracic aorta (DTA) thoracic endovascular aortic repair (TEVAR group) were retrospectively reviewed. We studied aortic remodeling only in patients with three-dimensional computed tomography scans available at 1 and 12 months following surgery (Standard group n = 26; Stent group n = 21).

RESULTS

At 1 month, abdominal aortic diameters were similar, but true lumen (TL) and true lumen to total diameter ratios (TL index [TLI]) in the DTA were significantly improved in the TEVAR group (P < 0.05). Mean number of fenestrations were similar (1.8 ± 1.5 vs. 2.4 ± 1.9, P = 0.32). At 12 months, DTA true lumen and TLI remained significantly improved in the TEVAR group at all locations (P < 0.01). This translated to increased complete false lumen thrombosis rates in the thoracic aorta (83% vs. 32%, P = 0.01) in the TEVAR group. In the Standard group, DTA true lumen diameter and TL index were significantly decreased at 12 months compared to 1 month time period (P < 0.05). In the TEVAR group, DTA true lumen diameters and TLI were significantly improved at 12 months (P < 0.05).

CONCLUSIONS

Antegrade TEVAR during open repair for DeBakey I dissection improves DTA remodeling by increasing true lumen diameter without enlargement of the total aortic diameter and by promoting false lumen thrombosis.

Authors+Show Affiliations

University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.Mercy Catholic Medical Center, Philadelphia, Pennsylvania.University of Pennsylvania Medical Center, Philadelphia, Pennsylvania.University of Pennsylvania Medical Center, Philadelphia, Pennsylvania.University of Pennsylvania Medical Center, Philadelphia, Pennsylvania.University of Pennsylvania Medical Center, Philadelphia, Pennsylvania.University of Pennsylvania Medical Center, Philadelphia, Pennsylvania.University of Pennsylvania Medical Center, Philadelphia, Pennsylvania.University of Pennsylvania Medical Center, Philadelphia, Pennsylvania.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28795434

Citation

Sultan, Ibrahim, et al. "Concomitant Antegrade Stent Grafting of the Descending Thoracic Aorta During Transverse Hemiarch Reconstruction for Acute DeBakey I Aortic Dissection Repair Improves Aortic Remodeling." Journal of Cardiac Surgery, vol. 32, no. 9, 2017, pp. 581-592.
Sultan I, Wallen TJ, Habertheuer A, et al. Concomitant antegrade stent grafting of the descending thoracic aorta during transverse hemiarch reconstruction for acute DeBakey I aortic dissection repair improves aortic remodeling. J Card Surg. 2017;32(9):581-592.
Sultan, I., Wallen, T. J., Habertheuer, A., Siki, M., Arnaoutakis, G. J., Bavaria, J., ... Vallabhajosyula, P. (2017). Concomitant antegrade stent grafting of the descending thoracic aorta during transverse hemiarch reconstruction for acute DeBakey I aortic dissection repair improves aortic remodeling. Journal of Cardiac Surgery, 32(9), pp. 581-592. doi:10.1111/jocs.13192.
Sultan I, et al. Concomitant Antegrade Stent Grafting of the Descending Thoracic Aorta During Transverse Hemiarch Reconstruction for Acute DeBakey I Aortic Dissection Repair Improves Aortic Remodeling. J Card Surg. 2017;32(9):581-592. PubMed PMID: 28795434.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Concomitant antegrade stent grafting of the descending thoracic aorta during transverse hemiarch reconstruction for acute DeBakey I aortic dissection repair improves aortic remodeling. AU - Sultan,Ibrahim, AU - Wallen,Tyler J, AU - Habertheuer,Andreas, AU - Siki,Mary, AU - Arnaoutakis,George J, AU - Bavaria,Joseph, AU - Szeto,Wilson Y, AU - Milewski,Rita, AU - Vallabhajosyula,Prashanth, Y1 - 2017/08/09/ PY - 2017/8/11/pubmed PY - 2017/11/29/medline PY - 2017/8/11/entrez KW - DeBakey I aortic dissection KW - TEVAR KW - aortic remodeling KW - type A aortic dissection SP - 581 EP - 592 JF - Journal of cardiac surgery JO - J Card Surg VL - 32 IS - 9 N2 - BACKGROUND AND AIM: Concomitant endovascular stent grafting of the descending thoracic aorta during open repair for acute DeBakey I aortic dissection can be performed in patients with extensive dissection and malperfusion. We analyzed the effects of this strategy on distal aortic remodeling. METHODS: From 2006-2014, acute DeBakey I dissection patients without primary aortic arch tear undergoing open distal hemiarch reconstruction (Standard group) versus those undergoing hemiarch with descending thoracic aorta (DTA) thoracic endovascular aortic repair (TEVAR group) were retrospectively reviewed. We studied aortic remodeling only in patients with three-dimensional computed tomography scans available at 1 and 12 months following surgery (Standard group n = 26; Stent group n = 21). RESULTS: At 1 month, abdominal aortic diameters were similar, but true lumen (TL) and true lumen to total diameter ratios (TL index [TLI]) in the DTA were significantly improved in the TEVAR group (P < 0.05). Mean number of fenestrations were similar (1.8 ± 1.5 vs. 2.4 ± 1.9, P = 0.32). At 12 months, DTA true lumen and TLI remained significantly improved in the TEVAR group at all locations (P < 0.01). This translated to increased complete false lumen thrombosis rates in the thoracic aorta (83% vs. 32%, P = 0.01) in the TEVAR group. In the Standard group, DTA true lumen diameter and TL index were significantly decreased at 12 months compared to 1 month time period (P < 0.05). In the TEVAR group, DTA true lumen diameters and TLI were significantly improved at 12 months (P < 0.05). CONCLUSIONS: Antegrade TEVAR during open repair for DeBakey I dissection improves DTA remodeling by increasing true lumen diameter without enlargement of the total aortic diameter and by promoting false lumen thrombosis. SN - 1540-8191 UR - https://www.unboundmedicine.com/medline/citation/28795434/Concomitant_antegrade_stent_grafting_of_the_descending_thoracic_aorta_during_transverse_hemiarch_reconstruction_for_acute_DeBakey_I_aortic_dissection_repair_improves_aortic_remodeling_ L2 - https://doi.org/10.1111/jocs.13192 DB - PRIME DP - Unbound Medicine ER -