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Strategy of TEVAR for acute aortic dissection

Strategy of TEVAR for acute aortic dissection. Osaka University Graduate school of Medicine, Division of Cardiovascular surgery Takuya Yoshida, Toru Kuratani, Kazuo Shimamura, Yukitoshi Shirakawa, Mugiho Takeuchi, Keiwa Kin, Yoshiki Sawa. Strategy of TEVAR for acute aortic dissection.

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Strategy of TEVAR for acute aortic dissection

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  1. Strategy of TEVAR for acute aortic dissection Osaka University Graduate school of Medicine, Division of Cardiovascular surgery Takuya Yoshida, Toru Kuratani, Kazuo Shimamura, Yukitoshi Shirakawa, Mugiho Takeuchi, Keiwa Kin, Yoshiki Sawa

  2. Strategy of TEVAR for acute aortic dissection ・ Minimal coverage of each thoracic intimal tear (short stent graft) ・ Strict sizing (proximal 110-115%, distal -110%)

  3. Objective To assess the outcome of TEVAR for acute aortic dissection with minimal intimal tear closure.

  4. Patient demographics Primary TEVAR for aortic dissection (1998－2009) in acute phase (<2week)36 cases Age 61.5±10.3 Gender (M/F)21 / 10 Type of dissection Type A 7 Type B 29 complicated Type B 17 uncomplicated Type B 12

  5. Device selection Homemade 29 Homemade + TAG 1 Homemade + Excluder cuff 2 TAG 2 Excluder cuff 2 Average length of the stent-graft 10.3 cm

  6. Representive case Pre operation Post operation 3.3cm Gore Aortic Extender Cuff

  7. Early Results Operative outcome Procedure success 36/36 (100%) Mortality 2 /36 (5.6%) (arrhythmia, intestinal necrosis) Morbidity Stroke 0 Spinal cord ischemia 0 Retrograde type A dissection 0 intimal tear creation 0 Iliac rupture 0 Endoleak at 1st postoperative CT 1 /36 (2.8%)

  8. TEVAR 40 35 Maximum diameter (mm) 30 P=.0091 Pre Post 6m 1y 3y 5y 7y Duration from TEAVR Diameter of DTA Thoracic false lumen thrombosis 32/36 (88.9%)

  9. Freedom from aortic death follow up: average 30.1±32.0 month, max 129month Stanford A: 100% Uncomplicated type B: 100% Freedom from aortic death (%) Over all: 94.4% Complicated type B: 88.2% month

  10. Long term results: Aortic event Stanford A Stanford B

  11. Type B: 71.8%/5year, 71.8%/10year Overall: 69.9%/5year, 69.9%/10year Freedom from aortic event (%) Type A: 50%/5year, 50%/10year month Freedom from aortic event

  12. Conclusions ・TEVAR with minimal coverage of each thoracic intimal tear provided good early phase protection. ・Although further investigation is necessary regarding late aortic events, this strategy may achieve the goal of false lumen thrombosis, without incurring the risks of covering the whole aorta.

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