Dataset Information

Recent evolution in use and effectiveness in mainland China of thoracic endovascular aortic repair of type B aortic dissection.

ABSTRACT: A meta-analysis was performed on 175 studies selected among those published in mainland China between 2008 and 2015 on thoracic endovascular aortic repair (TEVAR) for type B aortic dissection (AD). Most TEVAR were performed in Shanghai, Beijing, Hubei and Guangdong in patients with mean age of 53.9 years, and acute (70%) or chronic (30%) type B AD. Procedural success rate was 99.1?±?0.8%. Major complication rate was 1.7?±?2.3%, with paraplegia in 0.4?±?0.0%. Overall in-hospital mortality rate was 1.6?±?0.9% with AD rupture in 30% (about 40% during first postoperative day); follow-up mortality rate was 2.3?±?1.1%, with AD rupture in 39.2% (50% within first year). Compared with 2001-2007 data from China, there appeared to be improvement in rates of major complications, paraplegia and in-hospital mortality. Compared with 1999-2004 Western data, rates of procedural success, stroke, and paraplegia appeared similar, while those for major complications, in-hospital mortality, retrograde type A dissection and follow-up mortality appeared lower. Compared with more recent Western data (2006-2013) on acute complicated type B AD, stroke, paraplegia, in-hospital mortality and follow-up mortality appeared lower. Therefore, in mainland China, safety for TEVAR of type B AD appeared better between 2008 and 2015 than in previous periods in China or Western countries.

SUBMITTER: Xiong J

PROVIDER: S-EPMC5725573 | biostudies-literature | 2017 Dec

REPOSITORIES: biostudies-literature

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Recent evolution in use and effectiveness in mainland China of thoracic endovascular aortic repair of type B aortic dissection.

Xiong Jiang J Chen Chen C Wu Zhongyin Z Chen Duanduan D Guo Wei W

Scientific reports 20171211 1

A meta-analysis was performed on 175 studies selected among those published in mainland China between 2008 and 2015 on thoracic endovascular aortic repair (TEVAR) for type B aortic dissection (AD). Most TEVAR were performed in Shanghai, Beijing, Hubei and Guangdong in patients with mean age of 53.9 years, and acute (70%) or chronic (30%) type B AD. Procedural success rate was 99.1 ± 0.8%. Major complication rate was 1.7 ± 2.3%, with paraplegia in 0.4 ± 0.0%. Overall in-hospital mortality rate wa ...[more]

PMID: 29229954

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Project description:Background The treatment of chronic type B aortic dissection by thoracic endovascular aortic repair has some challenges, and its long-term outcomes remain unclear. This study aimed to analyze the 5-year clinical outcomes of thoracic endovascular aortic repair of chronic type B aortic dissection, compare the differences between patients with and without adverse aortic events (AAEs), and identify risk factors for AAEs. Methods and Results Patients who underwent thoracic endovascular aortic repair of chronic type B aortic dissection from January 2009 to June 2017 were retrospectively enrolled. The primary end points were AAEs, including aorta-related death, procedural complications, and disease progression requiring reintervention. Clinical outcomes were described at the 5-year follow-up visit. The secondary end point was the comparison of the results between patients with and without AAEs. Univariable and multivariable logistic analyses were used to identify potential risk factors for AAEs. A total of 214 patients were enrolled. AAEs occurred in 46 (21.5%) patients. Compared with patients without AAEs, those with AAEs had higher rates of residual type A aortic dissection (26.1% versus 4.2%, P<0.001) and aortic diameter ≥5.5 cm (69.6% versus 11.3%, P<0.001), and a lower rate of complete false lumen thrombosis (23.9% versus 89.9%, P<0.001). Meanwhile, the median interval from symptom onset to intervention was longer in patients with AAEs (26 months versus 12 months, P=0.004). Partial or no false lumen thrombosis (adjusted odds ratio [AOR], 14.71 [95% CI, 5.67-38.14; P<0.001]) and aortic diameter ≥5.5 cm (AOR, 10.16 [95% CI, 3.86-26.73; P<0.001]) were identified as independent risk factors for AAEs. Conclusions While thoracic endovascular aortic repair of chronic type B aortic dissection might be challenging in some cases, its long-term outcomes appeared promising as this treatment was effective in preventing catastrophic aortic events. Patients with AAEs showed higher rates of residual type A aortic dissection and aortic diameter ≥5.5 cm, a lower rate of complete false lumen thrombosis, and a longer median interval from symptom onset to intervention. Failure of complete false lumen thrombosis and an aortic diameter ≥5.5 cm were predictors of AAEs.

Project description:BackgroundRetrograde type A aortic dissection (RTAD) is a rare but life-threatening complication after thoracic endovascular aortic repair (TEVAR) for type B aortic dissection (TBAD). A graft inversion technique was applied to distal anastomosis in total arch replacement for this complicated dissection. We reviewed our results of the processing for this serious complication. The aim is to evaluate the feasibility of this technology.MethodsFrom January 2013 to December 2017, 20 patients (80% male, mean age 50.9 ± 9.5 years) with retrograde type A aortic dissection after thoracic endovascular aortic repair for type B aortic dissection were scheduled for surgical treatment at our center. All patients underwent an ascending aorta and total aortic arch replacement procedure. The 20 patients were divided into two groups, 1 group involved 9 patients underwent surgery using stepwise technique; the graft inversion technique was performed in the other group containing the remaining 11 patients. The postoperative variables, including cardiopulmonary bypass time, the circulatory arrest time, the aortic cross clamp time, were analyzed. Meanwhile we also analyzed the postoperative mortality and complications to evaluate the early and mid-term outcomes of surgical treatment for RTAD after TEVAR.ResultsIn-hospital mortality was 10% (2 of 20 patients). No patient developed postoperative paraplegia, renal failure, stroke, or distal anastomotic bleeding. Two patients developed renal insufficiency, one developed neurologic insufficiency, and one developed pulmonary infection, all of which were managed accordingly. Cardiopulmonary bypass (CPB) time, and circulatory arrest time were significantly shorter in the graft inversion group than in the stepwise group (165.8 ± 37.9 min versus 206.1 ± 46.8 min, p<0.05; 34.5 ± 5.6 min versus 42.4 ± 9.5 min, p<0.05, respectively). The 18 survivors had a mean follow-up of 25.8 ± 18.2 months, and all patients remained alive and well.ConclusionGraft inversion can enable a secure distal anastomosis under good surgical exposure, resulting in reduced durations of CPB, and circulatory arrest for RTAD after TEVAR. Surgical treatment could be a safe alternative for treatment of this patients.

Project description:BackgroundThe Food and Drug Administration has approved devices for endovascular management of thoracic endovascular aortic aneurysm repair (TEVAR); however, limited data exist describing the outcomes of TEVAR for aneurysms attributable to chronic type B aortic dissection (cTBAD). This study was undertaken to determine the results of endovascular treatment of cTBAD with aneurysmal degeneration.MethodsA retrospective analysis of all patients treated for cTBAD with aneurysmal degeneration at the University of Florida from 2004 to 2011 was performed. Computed tomograms with centerline reconstruction were analyzed to determine change in aortic diameter, relative proportions of aortic treatment lengths, and false lumen perfusion status. Reintervention and mortality were estimated using life-tables. Cox regression analysis was completed to predict mortality.ResultsEighty patients underwent TEVAR for aneurysm due to cTBAD (mean age [± standard deviation], 60 ± 13 years [male, 87.5%; n = 70]; median follow-up, 26 [range, 1-74] months). Median time from diagnosis of TBAD to TEVAR was 16 (range, 1-72) months. Prior aortic root/arch replacement had been performed in 29% (n = 23) at a median interval of 28.5 (range, 0.5-312) months. Mean preoperative aneurysm diameter was 62.0 ± 9.9 mm. In 75% (n = 60) of cases, coverage was proximal to zone 3, and 24% (n = 19) underwent carotid-subclavian bypass or other arch debranching procedure. Spinal drains were used in 78% (pre-op 71%, n = 57; post-op 6%, n = 5). Length of stay was 6.5 ± 4.7 days with a composite morbidity of 26% and in-hospital mortality of 2.5% (n = 2). Overall neurologic event rate was 17% (spinal cord ischemia 10% [n = 8], with a permanent deficit observed in 6.2% [n = 5]; stroke 7.5%). Aneurysm diameter reduced or stabilized in 65%. The false lumen thrombosed completely within the thoracic aorta in 52%, and reintervention within the treated aortic segment was required in 16% (n = 13).One- and 3-year freedom from reintervention (with 95% confidence interval [CI]) was 80% (range, 68%-88%) and 70% (range, 57%-80%), respectively. Survival at 1 and 5 years was 89% (range, 80%-94%) and 70% (range, 55%-81%) and was not significantly different among patients requiring reintervention or experiencing favorable aortic remodeling. Multivariable analysis identified coronary artery disease (hazard ratio [HR], 6.4; 95% CI, 2.3-17.7; P < .005), prior infrarenal aortic surgery (HR, 8.6; 95% CI, 2.3-31.7; P = .001), and congestive heart failure (HR, 11.9; 95% CI, 1.9-73.8; P = .008) as independent risk factors for mortality. Hyperlipidemia was found to be protective (HR, 0.2; 95% CI, 0.05-0.6; P = .004). No significant difference in predictors of mortality were found between patients who underwent reintervention vs those who did not (P = .2).ConclusionsTEVAR for cTBAD with aneurysmal degeneration can be performed safely but spinal cord ischemia rates may be higher than previously reported. Liberal use of procedural adjuncts to reduce this complication, such as spinal drainage, is recommended. Reintervention is common, but long-term survival does not appear to be impacted by remediation.

Dataset Information

Recent evolution in use and effectiveness in mainland China of thoracic endovascular aortic repair of type B aortic dissection.

Publications

Recent evolution in use and effectiveness in mainland China of thoracic endovascular aortic repair of type B aortic dissection.

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