Preoperative distal aortic diameter is a significant predictor of late aorta-related events after endovascular repair fo
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ORIGINAL ARTICLE
Preoperative distal aortic diameter is a significant predictor of late aorta‑related events after endovascular repair for chronic type B aortic dissection Yasuhisa Oishi1 · Yoshiyuki Yamashita1 · Satoshi Kimura1 · Hiromichi Sonoda1 · Sho Matsuyama1 · Tomoki Ushijima1 · Satoshi Fujita1 · Hideki Tatewaki1 · Yoshihisa Tanoue1 · Akira Shiose1 Received: 29 November 2019 / Accepted: 6 February 2020 © The Japanese Association for Thoracic Surgery 2020
Abstract Objectives Long-term therapeutic effects of thoracic endovascular aortic repair (TEVAR) for chronic type B aortic dissection remain controversial. This study aimed to evaluate the possible predictors of late aortic rupture and re-interventions after TEVAR. Methods We retrospectively reviewed the operative outcomes of 40 patients who underwent TEVAR for chronic type B aortic dissection at Kyushu University Hospital. During a mean follow-up period of 39.2 months, we assessed aortic morphology via computed tomography and then employed a multivariable Cox regression analysis in an attempt to identify the predictors of late aorta-related events. Results The early success rate of TEVAR was 100%. During the follow-up, however, three patients died from aortic rupture. Eight patients required aortic re-intervention, including thoraco-abdominal aortic graft replacement, repeated TEVAR, total arch replacement and EVAR. Multivariable Cox regression analysis revealed that the preoperative maximum distal aortic diameter was a significant predictor of late aorta-related events. The cutoff value of the distal aortic diameter was 40 mm. Freedom from aorta-related events was 94.6% at 1 year and 78.3% at 3 years. The survival rate was not significantly different despite the re-intervention. Conclusions TEVAR is an effective treatment for chronic type B dissection, with acceptable mid-term results. The preoperative distal aortic diameter is a significant risk factor for late aorta-related events. When the maximum distal aortic diameter is ≥ 40 mm, a therapeutic strategy should be developed taking into consideration the possible need for aortic re-intervention. Keywords Chronic type B dissection · Re-intervention · Staged operation · TEVAR
Introduction Medical treatment is the gold standard for addressing uncomplicated acute type B dissection, with a reported success rate of 80–90% [1–3]. Despite the optimal medical therapy, about 20–40% of these patients require a surgical intervention during the follow-up [1, 3–5]. When medical therapy Presented at the 72nd Annual Scientific Meeting of The Japanese Association for Thoracic Surgery. * Yasuhisa Oishi [email protected]‑u.ac.jp 1
Department of Cardiovascular Surgery, Faculty of Medicine, Kyushu University Graduate School of Medicine, 3‑1‑1 Maidashi, Higashi, Fukuoka 812‑8552, Japan
fails, two surgical methods are available. One is conventional graft replacement under cardiopulmonary bypass, and the other is thoracic endovascular aortic repair (TEVAR). The approaches of these methods are quite different,
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