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Midterm results with thoracic endovascular aortic repair for chronic type B aortic dissection with associated aneurysm.

Publication ,  Journal Article
Parsa, CJ; Williams, JB; Bhattacharya, SD; Wolfe, WG; Daneshmand, MA; McCann, RL; Hughes, GC
Published in: J Thorac Cardiovasc Surg
February 2011

OBJECTIVE: Thoracic endovascular aortic repair for chronic type B aortic dissection with associated descending thoracic aneurysm remains controversial. Concerns include potential ischemic complications due to branch vessel origin from the chronic false lumen and continued retrograde false lumen/aneurysm sac pressurization via fenestrations distal to implanted endografts. The present study examines midterm results with thoracic endovascular aortic repair for chronic (>2 weeks) type B aortic dissection with associated aneurysm to better understand the potential role of thoracic endovascular aortic repair for this condition. METHODS: Between March 2005 and December 2009, 51 thoracic endovascular aortic repair procedures were performed at a single institution for management of chronic type B dissection. The indication for thoracic endovascular aortic repair was aneurysm in all cases. A subset of 7 patients (14%) underwent placement of the EndoSure wireless pressure measurement system (CardioMEMS, Inc, Atlanta, Ga) in the false lumen adjacent to the primary tear for monitoring aneurysm sac/false lumen pulse pressure after thoracic endovascular aortic repair. RESULTS: Mean patient age was 57±12 years (range, 30-82 years); 14 patients (28%) were female. Mean aortic diameter was 6.2±1.4 cm. There were no in-hospital/30-day deaths, strokes, or permanent paraplegia/paresis. There were no complications related to compromise of downstream branch vessels arising from the false lumen. Two patients (3.9%) who had preexisting ascending aortic dilation had retrograde acute type A aortic dissection; both were repaired successfully. Median postoperative length of stay was 4 days. Mean follow-up is 27.0±16.5 months (range, 2-60 months). Actuarial overall survival is 77.7% at 60 months with an actuarial aorta-specific survival of 98% over this same time period. Actuarial freedom from reintervention is 77.3% at 60 months. All patients with the EndoSure wireless pressure measurement system exhibited a decrease in aneurysm sac/false lumen pulse pressure indicating a depressurized false lumen. The aneurysm sac/false lumen pulse pressure ratio decreased from 52%±27% at the predischarge measurement to 14%±5% at the latest follow-up reading (P=.029). CONCLUSIONS: Thoracic endovascular aortic repair for chronic type B dissection with associated aneurysm is safe and effective at midterm follow-up. Aneurysm sac/false lumen pulse pressure measurements demonstrate a significant reduction in false lumen endotension, thus ruling out clinically significant persistent retrograde false lumen perfusion and provide proof of concept for a thoracic endovascular aortic repair-based approach. Longer-term follow-up is needed to determine the durability of thoracic endovascular aortic repair for this aortic pathology.

Duke Scholars

Published In

J Thorac Cardiovasc Surg

DOI

EISSN

1097-685X

Publication Date

February 2011

Volume

141

Issue

2

Start / End Page

322 / 327

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Transducers, Pressure
  • Tomography, X-Ray Computed
  • Time Factors
  • Retrospective Studies
  • Respiratory System
  • Reoperation
  • North Carolina
  • Middle Aged
  • Male
 

Citation

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MLA
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Parsa, C. J., Williams, J. B., Bhattacharya, S. D., Wolfe, W. G., Daneshmand, M. A., McCann, R. L., & Hughes, G. C. (2011). Midterm results with thoracic endovascular aortic repair for chronic type B aortic dissection with associated aneurysm. J Thorac Cardiovasc Surg, 141(2), 322–327. https://doi.org/10.1016/j.jtcvs.2010.10.043
Parsa, Cyrus J., Judson B. Williams, Syamal D. Bhattacharya, Walter G. Wolfe, Mani A. Daneshmand, Richard L. McCann, and G Chad Hughes. “Midterm results with thoracic endovascular aortic repair for chronic type B aortic dissection with associated aneurysm.J Thorac Cardiovasc Surg 141, no. 2 (February 2011): 322–27. https://doi.org/10.1016/j.jtcvs.2010.10.043.
Parsa CJ, Williams JB, Bhattacharya SD, Wolfe WG, Daneshmand MA, McCann RL, et al. Midterm results with thoracic endovascular aortic repair for chronic type B aortic dissection with associated aneurysm. J Thorac Cardiovasc Surg. 2011 Feb;141(2):322–7.
Parsa, Cyrus J., et al. “Midterm results with thoracic endovascular aortic repair for chronic type B aortic dissection with associated aneurysm.J Thorac Cardiovasc Surg, vol. 141, no. 2, Feb. 2011, pp. 322–27. Pubmed, doi:10.1016/j.jtcvs.2010.10.043.
Parsa CJ, Williams JB, Bhattacharya SD, Wolfe WG, Daneshmand MA, McCann RL, Hughes GC. Midterm results with thoracic endovascular aortic repair for chronic type B aortic dissection with associated aneurysm. J Thorac Cardiovasc Surg. 2011 Feb;141(2):322–327.
Journal cover image

Published In

J Thorac Cardiovasc Surg

DOI

EISSN

1097-685X

Publication Date

February 2011

Volume

141

Issue

2

Start / End Page

322 / 327

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Transducers, Pressure
  • Tomography, X-Ray Computed
  • Time Factors
  • Retrospective Studies
  • Respiratory System
  • Reoperation
  • North Carolina
  • Middle Aged
  • Male