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Published on: March 28, 2025
Descending thoracic aortic repair outcomes for chronic aortic dissection: a single-centre experience
Yoshitaka Yamane1, Susumu Oshima1, Kazumasa Ishiko1
1Kawasaki Aortic Center, Kawasaki Saiwai Hospital, Kawasaki, Japan.
Insights
Thoracic endovascular aortic repair offers good early and long-term outcomes for chronic aortic dissection. This minimally invasive approach is considered a gold standard for low-risk patients.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Medical Devices
Background:
- Chronic aortic dissection poses significant risks.
- Thoracic endovascular aortic repair (TEVAR) is an alternative to open surgery.
- Evaluating TEVAR's efficacy in chronic aortic dissection is crucial.
Purpose of the Study:
- To assess early and long-term outcomes of TEVAR for chronic aortic dissection.
- To compare TEVAR results with historical open surgical repair data.
- To identify predictors of adverse events in TEVAR.
Main Methods:
- Retrospective analysis of 492 patients undergoing TEVAR for chronic aortic dissection (2012-2020).
- Follow-up duration median 3.2 years.
- Multivariable analysis to identify risk factors for early major adverse events.
Main Results:
- Early mortality was 2.0%, stroke 3.5%, and spinal cord injury 6.1%.
- Age >70 and non-elective surgery predicted adverse events.
- Low-risk patients had excellent outcomes: 0.4% mortality, 1.5% stroke, 0.4% spinal cord injury.
Conclusions:
- TEVAR demonstrates favorable early and long-term results for chronic aortic dissection.
- It is a viable gold standard treatment, especially for low-risk patient cohorts.
- Risk stratification is important for optimizing TEVAR outcomes.
Objectives:
Thoracic endovascular aortic repair is a widely accepted treatment for chronic aortic dissection because of good early results compared to open surgical repair. We provide early and long-term results of descending thoracic aortic repair for chronic aortic dissection.
Methods:
Patients who underwent descending thoracic aortic repair for chronic aortic dissection between January 2012 and December 2020 at Kawasaki Aortic Centre were included in this analysis.
Results:
Four hundred ninety-two patients (median age, 64 years; interquartile range, 52-75 years) were included. The median duration of follow-up was 3.2 years (interquartile range, 1.5-5.2 years). The early mortality rate was 2.0% (n = 10); strokes occurred in 17 patients (3.5%); and spinal cord injuries occurred in 30 patients (6.1%). Early major adverse events including early death, stroke, spinal cord injury, tracheostomy and haemodialysis at the time of discharge occurred in 62 patients. Multivariable analysis indicated that age > 70 years and non-elective surgery were predictors of early major adverse events. Among patients without both risk factors (i.e. low-risk patients), 1 early death (0.4%), 3 strokes (1.5%) and 1 spinal cord injury (0.4%) were observed, 2 tracheostomies were performed (0.8%) and no patients required haemodialysis at the time of hospital discharge. The 5-year survival rate was 87.2%. The cumulative incidence of chronic aortic dissection-related aortic reintervention at 5 years was 7.9%.
Conclusions:
Descending thoracic aortic repair for chronic aortic dissection resulted in good early and long-term results, and it can serve as the gold standard for low-risk patients.
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