Early and midterm results of thoracic endovascular aortic repair of chronic type B aortic dissection

Xu, Shang Dong; Huang, Fang Jiong; Yang, Jin Fei; Li, Zhi Zhong; Yang, Sheng; Du, Jia Hui; Zhang, Zhao Guang

doi:10.1016/j.jtcvs.2009.08.051

« Previous Next »The Journal of Thoracic and Cardiovascular Surgery
Volume 139, Issue 6 , Pages 1548-1553, June 2010

Early and midterm results of thoracic endovascular aortic repair of chronic type B aortic dissection

Shang Dong Xu, MD
- Division of Cardiac Surgery, Beijing Institute of Heart, Lung & Vascular Diseases, Capital Medical University, Beijing Anzhen Hospital, Beijing, China
- Address for reprints: Shang Dong Xu, MD, Beijing Anzhen Hospital, Cardiovascular Division, An Zhen Li, Chao Yang Qu, Beijing 100029, China.
Fang Jiong Huang, MD
- Division of Cardiac Surgery, Beijing Institute of Heart, Lung & Vascular Diseases, Capital Medical University, Beijing Anzhen Hospital, Beijing, China
Jin Fei Yang, MD
- Division of Cardiac Surgery, Beijing Institute of Heart, Lung & Vascular Diseases, Capital Medical University, Beijing Anzhen Hospital, Beijing, China
Zhi Zhong Li, MD
- Division of Cardiology, Beijing Institute of Heart, Lung & Vascular Diseases, Capital Medical University, Beijing Anzhen Hospital, Beijing, China
Sheng Yang, MD
- Division of Cardiac Surgery, Beijing Institute of Heart, Lung & Vascular Diseases, Capital Medical University, Beijing Anzhen Hospital, Beijing, China
Jia Hui Du, MD
- Division of Radiology, Beijing Institute of Heart, Lung & Vascular Diseases, Capital Medical University, Beijing Anzhen Hospital, Beijing, China
Zhao Guang Zhang, MD
- Division of Cardiac Surgery, Beijing Institute of Heart, Lung & Vascular Diseases, Capital Medical University, Beijing Anzhen Hospital, Beijing, China

Received 28 March 2009; received in revised form 30 July 2009; accepted 23 August 2009. published online 12 November 2009.

Objective

The optimal treatment for chronic type B dissection remains controversial. This study reports early and midterm results of thoracic endovascular aortic repair for chronic type B aortic dissection.

Methods

From June 2001 to September 2007, a total of 84 patients with chronic type B aortic dissection underwent thoracic endovascular aortic repair. The time between onset of dissection and thoracic endovascular aortic repair was 13.9 ± 22.0 months (range, 1–120 months). All patients were followed up from 6 to 86 months (mean, 33.2 ± 19.2 months).

Results

The entry tear was completely sealed in 77 cases (91.7%) during thoracic endovascular aortic repair. The incidence of incomplete seal was 8.3%. The 1-month mortality was 1.2%. One patient had retrograde type A dissection 1 month after the operation. Four patients underwent a second thoracic endovascular aortic repair during follow-up, for endoleak in 3 patients and for newly formed intimal tear in 1 patient. Seven patients (8.3%) died during follow-up. Three died of rupture of the thoracic aorta because of endoleak. The Kaplan–Meier actuarial survival curve showed a 5-year survival of 84.4%. At 5 years, 75.2% of patients were alive with neither endoleak nor reintervention.

Conclusions

Early and midterm results show that thoracic endovascular aortic repair was effective in the treatment of chronic type B aortic dissection. Endoleak was the main cause of death during follow-up. With increased surgical experience and refinement of the stent graft, results are likely to improve in the future.

CTSNet classification: 26, 28

Abbreviations and Acronyms: CTA, computed tomographic angiography, LSCA, left subclavian artery, TEVAR, thoracic endovascular aortic repair