Thoracic endovascular aortic repair (TEVAR) in proximal (type A) aortic dissection: Ready for a broader application?
Thoracic endovascular aortic repair (TEVAR) has demonstrated encouraging results and is gaining increasing acceptance as a treatment option for aortic aneurysms and dissections. Yet, its role in managing proximal aortic pathologies is unknown-this is important because in proximal (Stanford type A) aortic dissections, 10% to 30% are not accepted for surgery and 30% to 50% are technically amenable for TEVAR. We describe our case series of type A aortic dissections treated by using TEVAR.



Between year 2009 and 2016, 12 patients with acute, subacute, or chronic type A aortic dissection with the proximal entry tear located between the coronaries and brachiocephalic artery were treated with TEVAR at 3 centers. Various stent-graft configurations were used to seal the proximal entry tear in the ascending aorta under rapid pacing.



A total of 12 patients (9 male, 3 female), mean age 81 ± 7 years, EuroSCORE II 9.1 ± 4.5, underwent TEVAR for the treatment of type A aortic dissection. Procedural success was achieved in 11 of 12 patients (91.7%). There was 1 minor stroke and 1 intraprocedural death. No additional deaths were reported at 30 days. At 36 months, there were 4 further deaths (all from nonaortic causes). The mean survival of these 4 deceased was 23 months (range 15-36 months). Follow-up computed tomography demonstrated favorable aortic remodeling.



TEVAR is feasible and reveals promising early results in selected patients with type A aortic dissection who are poor candidates for surgical repair. The current iteration of stent-graft technology, however, needs to be adapted to features specific to the ascending aorta.
Royal Brompton Hospital, London, United Kingdom; National Heart and Lung Institute, Imperial College London, London, United Kingdom. Electronic address: c.nienaber@rbht.nhs.uk.
Christoph A
CA
Nienaber
Université Catholique de Liège, Liège, Belgium.
Natzi
N
Sakalihasan
Aortic Centre, Hôpital Cardiologique, CHRU Lille, Lille, France; Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom.
Rachel E
RE
Clough
Department of Cardiology, University Hospital Rostock, Rostock, Germany.
Mohamed
M
Aboukoura
Royal Brompton Hospital, London, United Kingdom.
Enrico
E
Mancuso
Royal Brompton Hospital, London, United Kingdom; National Heart and Lung Institute, Imperial College London, London, United Kingdom.
James S M
JS
Yeh
Université Catholique de Liège, Liège, Belgium.
Jean-Olivier
JO
Defraigne
Royal Brompton Hospital, London, United Kingdom.
Nick
N
Cheshire
Royal Brompton Hospital, London, United Kingdom.
Ulrich Peter
UP
Rosendahl
Royal Brompton Hospital, London, United Kingdom.
Cesare
C
Quarto
Royal Brompton Hospital, London, United Kingdom.
John
J
Pepper
D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000175:diagnosis / Q000601:surgery*; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000601:surgery*; D057510:Endovascular Procedures / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D011474:Prosthesis Design; D012189:Retrospective Studies; D015607:Stents; D019616:Thoracic Surgical Procedures / Q000379:methods*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
3D reconstruction; TEVAR; aortic repair; endovascular scaffold; stent-graft; type A aortic dissection