Key success factors for thoracic endovascular aortic repair for non-acute Stanford type B aortic dissection
Selected in European Journal of Cardio-Thoracic Surgery by Rylski
Tadashi Kitamura, Shinzo Torii, Norihiko Oka, Tetsuya Horai, Kouki Nakashima, Keiichi Itatani, Sachi Koyama, Yosuke Hari, Haruna Araki, Hajime Sato and Kagami Miyaji
Eur J Cardiothorac Surg. 2014;46:432-437
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Thoracic endovascular aortic repair (TEVAR) is more and more frequently applied in patients with Stanford type B aortic dissection. The authors aimed to determine the key factors predicting successful outcome after TEVAR in non-acute type B dissection patients.
- Forty-five patients underwent 53 TEVAR procedures for non-acute type B dissection.
- No early mortality was observed.
- Survival was 86 and 63%, freedom from aortic reintervention 73 and 59%, freedom from open aortic surgery 84 and 73% at 5 and 10 years.
- Twenty five of 34 (73%) patients with primarily patent false lumen before TEVAR had their descending false lumen thrombosed at follow-up.
- Absence of abdominal branches arising from the false lumen was associated with complete obliteration of the false lumen.
Endovascular aortic repair in patients with type B aortic dissection is an alternative for medical treatment. The goal of TEVAR is the prevention of aortic dilatation by closing entries and stimulating the false lumen thrombosis. INSTEAD study proved that TEVAR had a positive impact on remodeling of the dissected descending aorta. However, TEVAR is still controversial for uncomplicated type B dissection. On the last CX Symposium in London Peter Taylor and Richard Gibbs (Imperial College, London, UK) persuaded 70% of the audience to vote against the motion “For uncomplicated type B dissection, early intervention is indicated”. However, Christoph Nienaber (Rostock, Germany) and Jan Brunkwall (Köln, Germany) convinced 30% of the same audience that early TEVAR improve the outcome in patients with uncomplicated type B dissection. We are observing a shift in the paradigm for type B dissection treatment. Above-mentioned paper comes from group which treats endovascularly also uncomplicated type B dissections. The authors provide important data on success factors for TEVAR in type B dissection. Their results support the hypothesis, that the key to success is inducing the false lumen thrombosis, which was achieved in the majority of their patients.