Thoracic endovascular aortic repair for retrograde type A aortic dissection

Area of Science:

• Cardiovascular Surgery
• Endovascular Interventions
• Aortic Diseases

Background:

• Retrograde type A aortic dissection (r-TAAD) with entry tear in the descending aorta presents unique management challenges.
• The efficacy of thoracic endovascular aortic repair (TEVAR) in this specific r-TAAD subtype remains incompletely understood.

Purpose of the Study:

• To evaluate the safety and efficacy of TEVAR for patients diagnosed with r-TAAD.
• To assess long-term survival and aorta-related adverse event rates following TEVAR in this patient cohort.

Main Methods:

• Retrospective review of 31 patients who underwent TEVAR for r-TAAD across three institutions (1997-2016).
• Analysis of patient demographics, dissection characteristics, TEVAR timing (acute vs. subacute), and clinical outcomes.

Main Results:

• The study included 31 patients (mean age 64 years); all had entry tears in the descending thoracic aorta.
• Thirty-day mortality was low (3%), with early adverse events in 26% requiring reintervention in 5 patients.
• Long-term survival rates at 1, 5, and 10 years were 97%, 93%, and 80%, respectively, though late adverse events occurred in 23% of patients.

Conclusions:

• TEVAR demonstrates promising survival outcomes for r-TAAD.
• A significant incidence of postoperative aorta-related adverse events necessitates careful patient selection.
• Mandatory close follow-up is essential to mitigate potential catastrophic complications after TEVAR for r-TAAD.