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SUBACUTE VERSUS CHRONIC TYPE B AORTIC DISSECTION
1000 JACC March 21, 2017 Volume 69, Issue 11
Interventional Cardiology COMPARISON OF AORTIC REMODELING AFTER THORACIC ENDOVASCULAR REPAIR BETWEEN ACUTE/SUBACUTE VERSUS CHRONIC TYPE B AORTIC DISSECTION Poster Contributions Poster Hall, Hall C Friday, March 17, 2017, 10:00 a.m.-10:45 a.m. Session Title: Head to Toe: Outcomes of Endovascular Interventions Abstract Category: 18. Interventional Cardiology: Carotid and Endovascular Intervention Presentation Number: 1112-120 Authors: Yeongmin Woo, Young-Guk Ko, Chul-Min Ahn, Do-Yun Lee, Donghoon Choi, Yonsei Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea Background: The rate of successful thrombosis and negative remodeling of the false lumen after thoracic endovascular aortic repair (TEVAR) varies among studies and different patient subsets. This study compared aortic remodeling and clinical outcomes after TEVAR between acute and chronic type B aortic dissection.
Methods: A total of 64 patients with Type B aortic dissection treated with TEVAR were enrolled in this single-center, retrospective analysis. Patients were divided into acute/subacute (≤ 6 weeks, n=25), and chronic (>6 weeks, n=39) aortic dissection group according to interval between the symptom onset and date of TEVAR. Changes in diameter of total aorta and true and false lumen based on serial computed tomography (CT) images after TEVAR and adverse aortic event defined as a composite of aortic rupture, reintervention, and aorta dilation > 5mm were compared between the two groups.
Results: Patients’ mean age was 56 years and males were 70%. There was no significant difference in procedure-related complications between the two groups. The mean maximal diameter of thoracic aorta was 54.4 ± 12.8mm after TEVAR, and was decreased to 49.4 ± 12.3mm at 1-year follow-up. Reduction of total thoracic aortic diameter (>5 mm) was found in 40% of the acute/subacute group, and in 43.5% of the chronic group, whereas increase in aortic diameter >5 mm was observed in 0% of the acute/subacute group and 15.4% of the chronic group (p=0.08). Adverse aortic event was observed in 4.0% in the acute/subacute group and in 25.6% in the chronic group (p=0.03) Conclusions: TEVAR for Type B aortic dissection showed a trend towards more favorable aorta remodeling in the acute/subacute phase than in the chronic phase. Adverse aortic event was more frequent in chronic phases than in the acute/subacute phase. Therefore, TEVAR for Type B aortic dissection may need to be considered in acute/subacute phase for better outcomes.
Interventional Cardiology COMPARISON OF AORTIC REMODELING AFTER THORACIC ENDOVASCULAR REPAIR BETWEEN ACUTE/SUBACUTE VERSUS CHRONIC TYPE B AORTIC DISSECTION Poster Contributions Poster Hall, Hall C Friday, March 17, 2017, 10:00 a.m.-10:45 a.m. Session Title: Head to Toe: Outcomes of Endovascular Interventions Abstract Category: 18. Interventional Cardiology: Carotid and Endovascular Intervention Presentation Number: 1112-120 Authors: Yeongmin Woo, Young-Guk Ko, Chul-Min Ahn, Do-Yun Lee, Donghoon Choi, Yonsei Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea Background: The rate of successful thrombosis and negative remodeling of the false lumen after thoracic endovascular aortic repair (TEVAR) varies among studies and different patient subsets. This study compared aortic remodeling and clinical outcomes after TEVAR between acute and chronic type B aortic dissection.
Methods: A total of 64 patients with Type B aortic dissection treated with TEVAR were enrolled in this single-center, retrospective analysis. Patients were divided into acute/subacute (≤ 6 weeks, n=25), and chronic (>6 weeks, n=39) aortic dissection group according to interval between the symptom onset and date of TEVAR. Changes in diameter of total aorta and true and false lumen based on serial computed tomography (CT) images after TEVAR and adverse aortic event defined as a composite of aortic rupture, reintervention, and aorta dilation > 5mm were compared between the two groups.
Results: Patients’ mean age was 56 years and males were 70%. There was no significant difference in procedure-related complications between the two groups. The mean maximal diameter of thoracic aorta was 54.4 ± 12.8mm after TEVAR, and was decreased to 49.4 ± 12.3mm at 1-year follow-up. Reduction of total thoracic aortic diameter (>5 mm) was found in 40% of the acute/subacute group, and in 43.5% of the chronic group, whereas increase in aortic diameter >5 mm was observed in 0% of the acute/subacute group and 15.4% of the chronic group (p=0.08). Adverse aortic event was observed in 4.0% in the acute/subacute group and in 25.6% in the chronic group (p=0.03) Conclusions: TEVAR for Type B aortic dissection showed a trend towards more favorable aorta remodeling in the acute/subacute phase than in the chronic phase. Adverse aortic event was more frequent in chronic phases than in the acute/subacute phase. Therefore, TEVAR for Type B aortic dissection may need to be considered in acute/subacute phase for better outcomes.