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ANALYSIS OF THE TIMING OF THORACIC ENDOVASCULAR AORTIC REPAIR AND ITS INDICATIONS AND OUTCOMES IN TYPE B AORTIC DISSECTION
2077 JACC March 21, 2017 Volume 69, Issue 11
Vascular Medicine ANALYSIS OF THE TIMING OF THORACIC ENDOVASCULAR AORTIC REPAIR AND ITS INDICATIONS AND OUTCOMES IN TYPE B AORTIC DISSECTION Poster Contributions Poster Hall, Hall C Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m. Session Title: Beans, Beans, Good for Your Heart Abstract Category: 39. Vascular Medicine: Endovascular Therapy Presentation Number: 1255-360 Authors: Yimin Chen, Thomas Gleason, Udo Sechtem, Kevin Harris, Amit Korach, Takeyoshi Ota, Sherene Shalhub, Linda Pape, G. Chad Hughes, Kevin Greason, Kim Eagle, Daniel Montgomery, Eric Isselbacher, Christoph Nienaber, Marek Ehrlich, Himanshu Patel, University of Michigan Medical School, Ann Arbor, MI, USA
Background: Thoracic Endovascular Aortic Repair (TEVAR) is often used to treat Type B acute aortic dissection. Although initially reserved for patients with complications, recent studies have also shown improved 5-year aorta-specific mortality in uncomplicated patients. Despite an increased focus on the utilization of this procedure in Type B dissections presenting in the acute phase, optimal timing and patient selection is still unclear. Methods: Utilizing data from the International Registry of Acute Aortic Dissection, we compared indications and outcomes for 205 Type B patients who received TEVAR <24 hours after symptom onset (n=82, 40%) with those who received the procedure 2-30 days after symptom onset (n=123, 60%).
Results: Among the patients evaluated, those who received TEVAR <24 hours after symptom onset had significantly higher rates of emergent indications for repair, including malperfusion (75.0% v. 47.1%, p=0.045), pulse deficit (50.0% v. 28.9%, p=0.014), limb ischemia (36.8% v. 18.1%, p=0.005), ischemic peripheral neuropathy (16.7% v. 3.6%, p=0.003), and periaortic hematoma (27.7% vs. 13.0%, p=0.018), than those who received TEVAR later. Patients who received TEVAR <24 hours after symptom onset also had significantly higher rates of post-procedure mortality (19.5% v. 8.9%, p=0.020) and complications, including neurological deficit (21.9% vs. 7.8%, p=0.005), spinal cord ischemia (9.5% vs. 2.7%, p=0.047), and acute renal failure (30.0% vs. 10.3%, p=0.001). Conclusions: Patients who received TEVAR earlier were more likely to have emergent indications and suffer post-procedure mortality and morbidity. In contrast, those who underwent delayed TEVAR were initially more stable, and fared better post-intervention. While these findings indicate delayed TEVAR beyond the hyperacute phase may be beneficial for those who are stable enough to wait, more analysis is needed to distinguish whether these effects are related to the timing of the procedure or initial indications.
Vascular Medicine ANALYSIS OF THE TIMING OF THORACIC ENDOVASCULAR AORTIC REPAIR AND ITS INDICATIONS AND OUTCOMES IN TYPE B AORTIC DISSECTION Poster Contributions Poster Hall, Hall C Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m. Session Title: Beans, Beans, Good for Your Heart Abstract Category: 39. Vascular Medicine: Endovascular Therapy Presentation Number: 1255-360 Authors: Yimin Chen, Thomas Gleason, Udo Sechtem, Kevin Harris, Amit Korach, Takeyoshi Ota, Sherene Shalhub, Linda Pape, G. Chad Hughes, Kevin Greason, Kim Eagle, Daniel Montgomery, Eric Isselbacher, Christoph Nienaber, Marek Ehrlich, Himanshu Patel, University of Michigan Medical School, Ann Arbor, MI, USA
Background: Thoracic Endovascular Aortic Repair (TEVAR) is often used to treat Type B acute aortic dissection. Although initially reserved for patients with complications, recent studies have also shown improved 5-year aorta-specific mortality in uncomplicated patients. Despite an increased focus on the utilization of this procedure in Type B dissections presenting in the acute phase, optimal timing and patient selection is still unclear. Methods: Utilizing data from the International Registry of Acute Aortic Dissection, we compared indications and outcomes for 205 Type B patients who received TEVAR <24 hours after symptom onset (n=82, 40%) with those who received the procedure 2-30 days after symptom onset (n=123, 60%).
Results: Among the patients evaluated, those who received TEVAR <24 hours after symptom onset had significantly higher rates of emergent indications for repair, including malperfusion (75.0% v. 47.1%, p=0.045), pulse deficit (50.0% v. 28.9%, p=0.014), limb ischemia (36.8% v. 18.1%, p=0.005), ischemic peripheral neuropathy (16.7% v. 3.6%, p=0.003), and periaortic hematoma (27.7% vs. 13.0%, p=0.018), than those who received TEVAR later. Patients who received TEVAR <24 hours after symptom onset also had significantly higher rates of post-procedure mortality (19.5% v. 8.9%, p=0.020) and complications, including neurological deficit (21.9% vs. 7.8%, p=0.005), spinal cord ischemia (9.5% vs. 2.7%, p=0.047), and acute renal failure (30.0% vs. 10.3%, p=0.001). Conclusions: Patients who received TEVAR earlier were more likely to have emergent indications and suffer post-procedure mortality and morbidity. In contrast, those who underwent delayed TEVAR were initially more stable, and fared better post-intervention. While these findings indicate delayed TEVAR beyond the hyperacute phase may be beneficial for those who are stable enough to wait, more analysis is needed to distinguish whether these effects are related to the timing of the procedure or initial indications.