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Original Articles: Adult Cardiac

Endovascular Treatment of Type B Aortic Dissection: The Challenge of Late Success

^a Department of Cardiothoracic Surgery, Federal University of São Paulo, Paulista School of Medicine, São Paulo, Brazil
^b Department of Cardiology, Federal University of São Paulo, Paulista School of Medicine, São Paulo, Brazil
^c Hospital do Coração da Associação do Sanatório Sírio, São Paulo, Brazil

Accepted for publication February 18, 2009.

^_* Address correspondence to Dr Rodrigues Alves, Rua Simão Álvares, no 527, Apto 63, São Paulo-SP, CEP-05417-030, Brazil (Email: cmralves{at}uol.com.br).

Background: Thoracic endovascular aortic repair of type B aortic dissection is a therapeutic option for selected patients. However, late outcomes of this intervention are virtually unknown, and the series already published are heterogenous regarding demographics, indications, and type of devices.

Methods: From 1997 to 2004, 106 patients exclusively with classic complicated or symptomatic type B aortic dissection were treated with thoracic endovascular aortic repair, using the same device. We present in-hospital outcomes and late follow-up for 73 patients.

Results: Technical success was achieved for 99% of patients, and the clinical success rate was 83% (exclusion of the false lumen, no early death or surgical conversion). In-hospital death occurred in 5 patients, 2 of them after surgical conversion. Three patients required urgent surgical conversion. Neurologic complications occurred in 5 patients (1 case of paraplegia). The average time of follow-up was 35.9 ± 28.5 months. During follow-up, 37% of patients initially successfully treated reached a failure criterion (new endovascular or surgical intervention in the same aortic segment or death due to aortic or unknown cause). Kaplan-Meier curve showed late survival rates higher than 80% in 2 years.

Conclusions: Patients with both acute and chronic type B aortic dissection had excellent initial results with thoracic endovascular aortic repair. Although event-free survival rates decreased gradually with time owing to the frequent need for new interventions, survival curves were comparable to those for less complex patients undergoing clinical or surgical treatment. Randomized studies are required to establish the actual benefit of this new approach.

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