Yasunori Iida
Nationality
Japan
Current Position
Chief director
Organization
Saiseikai Yokohamashi Tobu Hospital
Thoracic Aorta (II) Session

Topic: Extended thoracic endovascular aortic repair for residual aortic dissection after type A aortic dissection repair

Abstract

Objective: We investigated the outcomes of extended coverage of the descending thoracic aorta

(DTA) by thoracic endovascular aortic repair (TEVAR) for residual type B aortic dissection after
type A aortic dissection (TAAD) repair.
Methods: From November 2015 to August 2022, 49 patients underwent the above-mentioned procedure. We specifically investigated the outcomes of extended TEVAR for treatment of residual intimal tear after TAAD repair from November 2015 to August 2022.
Results: The initial TAAD repair were total arch replacement (TAR, n = 5), TAR + graft elephant trunk (ET, n = 9), TAR + frozen ET (n = 26), aortic valve remodeling + partial arch replacement (PAR) (n = 1), Bentall operation + ascending aortic replacement (AAR) (n = 1), Bentall operation + PAR (n = 1), Bentall operation + PAR + CABG (n = 1), PAR (n = 3), and hemi-arch replacement (HAR) (n = 2). TEVAR consisted of isolated TEVAR (n = 42), 1-debranching TEVAR (n = 6), and 2-debranching TEVAR (n = 1). The mean time from TAAD repair to TEVAR was 26 months. Technical success of TEVAR was 100%. The distal ends of the stent grafts were Th 8 (n = 1), Th 9 (n = 5), Th 10 (n = 6), Th 11 (n = 10), Th 12 (n = 23), L1 (n = 3), and L2 (n = 1), with an average of Th 11. The average length of hospitalization after TEVAR was 8 days. There were no surgical/in-hospital deaths or complications. The average postoperative follow-up period was 39 months without death or reintervention.
Conclusions: The short-term outcomes of extended TEVAR for residual type B aortic dissection
after TAAD repair were acceptable. Extended TEVAR may be a preemptive treatment for the downstream aorta. Mid- to long-term results should be clarified.

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Abstract