Aortic Remodeling and Clinical Outcomes in Type B Aortic Dissection According to the Timing of Thoracic Endovascular Aortic Repair

초록

Background: The objective of the study was to investigate aortic remodeling and clinical outcomes after thoracic endovascular aortic repair (TEVAR) for type B aortic dissection (AD) according to timing of the procedure. Methods: A total of 87 patients with type B AD who underwent TEVAR at 2 centers were included in this retrospective analysis. Patients were divided into acute/subacute (≤6 weeks, n = 35), early chronic (6 weeks to 1 year, n = 20), and late chronic (>1 year, n = 32) groups according to the timing of TEVAR after symptom onset. Changes in aorta dimensions on serial computed tomography angiograms and clinical outcomes were evaluated. Results: AD complications were the most common indication for TEVAR in the acute/subacute group, whereas aortic expansion was the main reason in the early and late chronic groups. Maximum total aorta diameter (46.6 ± 10.6 vs. 54.8 ± 9.8 vs. 56.7 ± 10.1 mm, P < 0.001) and false lumen diameter (30.9 ± 11.0 vs. 35.2 ± 12.0 vs. 39.9 ± 13.4 mm, P = 0.013) were smaller in the acute/subacute group than in the early and late chronic groups. At 1-year follow-up, maximum total aorta diameter was decreased in the acute/subacute and early chronic groups and increased in the late chronic group (−4.3 ± 9.3 vs. −5.2 ± 6.9 vs. 2.5 ± 4.6 mm, P < 0.001). Survival free from the major adverse aortic event (death, aortic rupture, or reintervention) at 5 years after TEVAR was lowest in the late chronic group (92.6% vs. 88.2% vs. 73.1%, P = 0.033) but not significantly different between the acute/subacute and early chronic groups (P = 0.680). Conclusions: TEVAR in the acute/subacute and early chronic phases of type B AD resulted in similar aortic remodeling and clinical outcomes, which were more favorable than those with TEVAR performed during late chronic AD. This finding suggests 1 year after the onset of type B AD symptoms as the upper time threshold for TEVAR to achieve optimal aortic remodeling and safety. © 2020 Elsevier Inc.