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Research Article|Articles in Press

Progression of Distal Aorta after Endovascular Fenestration/Stenting in Acute Type A Aortic Dissection with malperfusion syndrome

Open AccessPublished:March 09, 2023DOI:https://doi.org/10.1016/j.xjon.2023.02.015
Progression of Distal Aorta after Endovascular Fenestration/Stenting in Acute Type A Aortic Dissection with malperfusion syndrome
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      ABSTRACT

      Objective

      To evaluate the progression of dissected distal aorta in acute type A aortic dissection (ATAAD) patients with malperfusion syndrome (MPS) treated with endovascular fenestration/stenting and delayed open aortic repair

      Methods

      From 1996-2021, 927 patients presented with ATAAD. Of these, 534 had DeBakey I dissection with no-MPS and underwent emergency open aortic repair (no-MPS group), while 97 patients with MPS underwent fenestration/stenting and delayed open aortic repair (MPS group). Sixty-three patients with MPS treated with fenestration/stenting were excluded due to no open aortic repair: including death from organ failure (n=31), aortic rupture (n=16) and discharge alive (n=16).

      Results

      Compared to the no-MPS group, the MPS group had more patients with acute renal failure (60% vs. 4.3%, p<0.001. Both groups had similar aortic root and arch procedures. Postoperatively, the MPS group had similar operative mortality (5.2% vs. 7.9%, p=0.35) and permanent dialysis (4.7% vs. 2.9%, p=0.50), but more new-onset dialysis (22% vs. 7.7%, p<0.001) and prolonged ventilation (72% vs. 49%, p<0.001). The growth rate of the aortic arch (0.38 vs 0.35 mm/year, p=0.81) was similar between the MPS and no-MPS groups. The descending thoracic aorta (1.03 vs. 0.68 mm/year, p=0.001) and abdominal aorta growth rate (0.76 vs. 0.59 mm/year, p=0.02) were significantly higher in the MPS group. The cumulative incidence of reoperation over 10 years (18% vs. 18%, p=0.81) and 15-year survival outcome (50% vs 48%, p=0.43) were similar between MPS and no-MPS groups.

      Conclusions

      Endovascular fenestration/stenting followed by delayed open aortic repair was a valid approach for patients with MPS.

      Graphical abstract

      Figure thumbnail fx1
      Graphical Abstract

      KEYWORDS

      GLOSSARY OF ABBREVIATIONS:

      ATAAD (Acute type A aortic dissection), MPS (Malperfusion syndrome), STS (Society of Thoracic Surgeons), TEVAR (Thoracic endovascular aneurysm repair), EVAR (Endovascular aneurysm repair), CT (Computed tomography)

      Article info

      Publication history

      Accepted: February 24, 2023
      Received: May 8, 2022

      Publication stage

      In Press Journal Pre-Proof

      Footnotes

      Conflict of Interest: None related to this study.

      Funding Source: Dr. Yang is supported by the NHLBI of NIH K08HL130614, R01HL141891, and R01HL151776, Phil Jenkins and Darlene & Stephen J. Szatmari Funds.

      Date and number of IRB Approval: HUM00133791; 12/3/2017 A waiver of informed consent was obtained.

      CENTRAL PICTURE LEGEND: Descending thoracic aortic growth in ATAAD patients with or without malperfusion syndrome

      CENTRAL MESSAGE

      After endovascular fenestration/stenting and delayed open aortic repair, patients with malperfusion syndrome had faster aortic growth, similar reoperation and long-term survival vs patients without.

      PERSPECTIVE STATEMENT

      Upfront aortic fenestration/stenting followed by delayed open aortic repair was a valid approach in treating acute Type A dissection patients with malperfusion syndrome based on the comparable short- and long-term survival, aortic growth, and cumulative incidence of reoperation to patients without any malperfusion syndrome.

      Identification

      DOI: https://doi.org/10.1016/j.xjon.2023.02.015

      Copyright

      © 2023 The Author(s). Published by Elsevier Inc. on behalf of The American Association for Thoracic Surgery

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