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Original Articles: Adult Cardiac

Results of a New Surgical Paradigm: Endovascular Repair for Acute Complicated Type B Aortic Dissection

^a Division of Cardiovascular Surgery, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania
^b Division of Vascular Surgery, Department of Surgery, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania
^c Department of Neurology, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania

Accepted for publication April 1, 2008.

^_* Address correspondence to Dr Szeto, Divison of Cardiovascular Surgery, Department of Surgery, Hospital of University of Pennsylvania, University of Pennsylvania Medical Center, 3400 Spruce St, 6th Silverstein, Philadelphia, PA 19104 (Email: szetow{at}uphs.upenn.edu).

Presented at the Forty-fourth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 28–30, 2008.

Background: Conventional open repair of acute complicated type B aortic dissection is associated with significant morbidity and mortality. This study examined the results of thoracic endovascular aortic repair (TEVAR) in acute type B aortic dissection complicated with rupture or malperfusion syndrome.

Methods: From 2004 through 2007, 35 patients (22 men) with acute complicated type B aortic dissection were treated with TEVAR. Indications included rupture in 18 (51.4%) and malperfusion syndrome in 17 (48.6%; mesenteric or renal, 5;lower extremities, 3; both, 9). Three types of endograft devices were used (mean per patient, 1.9 devices). Intravascular ultrasound imaging was used in 15 patients (42.8%). In patients with malperfusion syndrome, distal adjunct procedures to expand the true lumen included infrarenal aortic stents in 4, mesenteric/renal stents in 4, and iliofemoral stents in 7. Follow-up was 93.9% during a period of 18.3 months (range, 3 to 47 months).

Results: The mean age was 58.6 ± 13.4 years. Technical success (coverage of the primary tear site) was achieved in 34 patients (97.1%). Coverage of the left subclavian artery was required in 25 patients (71.4%). Thirty-day mortality was 2.8%. One-year survival was 93.4% ± 4.6%. Complications included permanent renal failure (2.8%), stroke (2.8%), spinal cord ischemia (transient [5.7%], permanent [(2.8%]), and vascular access (14.2%). The mean intensive care unit and hospital stay were 4.7 ± 2.6 and 16.7 ± 12.0 days, respectively.

Conclusions: Endovascular repair of acute complicated type B aortic dissection is associated with low morbidity and mortality and has emerged as the surgical therapy of choice.