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Thoracic Endovascular Aortic Repair (TEVAR) in Proximal (Type A) Aortic Dissection: Ready for a Broader Application?

Research output: Contribution to journalArticle

Christoph A. Nienaber, Natzi Sakalihasan, Rachel E. Clough, Mohamed Aboukoura, Enrico Mancuso, James S.M. Yeh, Jean-Olivier Defraigne, Nick Cheshire, Ulrich Peter Rosendahl, Cesare Quarto, John Pepper

Original languageEnglish
JournalJournal of Thoracic and Cardiovascular Surgery
Early online date29 Aug 2016
DOIs
Publication statusE-pub ahead of print - 29 Aug 2016

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Abstract

Objective

Thoracic endovascular aortic repair (TEVAR) has demonstrated encouraging results and is gaining increasing acceptance as a treatment option for aortic aneurysms and dissections. Yet, its role in managing proximal aortic pathologies is unknown - this is important because in proximal (Stanford type A) aortic dissections, 10-30% are not accepted for surgery, and 30-50% are technically amenable for TEVAR. We describe our case series of type A aortic dissections treated using TEVAR.
Methods

Between year 2009 and 2016, 12 patients with acute, subacute or chronic type A aortic dissection with the proximal entry tear located between the coronaries and brachiocephalic artery were treated with TEVAR at 3 centers. Various stent-graft configurations were used to seal the proximal entry tear in the ascending aorta under rapid pacing.
Results

12 patients (9 male, 3 female), mean age 81±7 years, EuroSCORE II 9.1±4.5, underwent TEVAR for the treatment of type A aortic dissection. Procedural success was achieved in 11/12 patients (91.7%). There was one intra-procedural death and one minor stroke. No additional deaths at 30 days. At 36 months, there were 4 further deaths (all from non-aortic causes). The mean survival of these 4 deceased was 23 months (range 15-36 months). Follow-up computed tomography demonstrated favorable aortic remodeling.
Conclusion

TEVAR is feasible and reveals promising early results in selected patients with type A aortic dissection who are poor candidates for surgical repair. The current iteration of stent-graft technology however needs to be adapted to the specific features of the ascending aorta.

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