Acute type I aortic dissection with or without antegrade stent delivery: Mid-term outcomes

J Thorac Cardiovasc Surg. 2019 Nov;158(5):1273-1281. doi: 10.1016/j.jtcvs.2018.11.145. Epub 2019 Mar 9.

Abstract

Objective: We determined the effect of antegrade stent delivery in the descending thoracic aorta on short- and mid-term clinical and imaging outcomes for patients who underwent repair of acute DeBakey type I aortic dissection.

Methods: Outcomes were evaluated for 178 patients who underwent acute type I aortic dissection between 2005 and 2016 (standard repair, n = 115 [64.6%]; antegrade stent delivery, n = 63 [35.4%]). Propensity score match and multivariable analyses were performed to assess outcomes.

Results: The stent and standard repair groups had similar rates of operative mortality (30-day or in-hospital) (12.7% vs 17.4%, P = .41), persistent stroke (6.3% vs 5.3%, P = .75), and persistent paraplegia/paraparesis (1.6% vs 0.9%, P = 1.0). Propensity score match analysis indicated that the operative mortality rate was higher in the standard repair group (P = .059), which the multivariable analysis confirmed. The persistent stroke rate was nonsignificantly higher in the stent group (P = .66). Persistent paraplegia/paraparesis rates were similar in both groups (P = 1.0), and the overall rates of spinal cord ischemia were nonsignificantly higher in the stent group (P = .18). During follow-up (mean duration, 4.6 ± 3.6 y), computed tomography showed that stented patients more often had remodeling of the descending thoracic aorta (P = .0002) and somewhat more often had remodeling of the thoracoabdominal aorta (P = .13). Stented patients also had fewer subsequent procedures (P = .25). The 3- and 5-year survivals were 73.3% ± 6.9% and 49.9% ± 7.6% in the matched stented group and 66.3% ± 9.4% and 41.6% ± 7.7% in the matched standard group, respectively (P = .015 for overall survival).

Conclusions: In the short term, antegrade stent delivery was associated with less operative mortality. In the mid-term, promising remodeling of the false lumen was seen in stented patients, as were (nonsignificantly) lower rates of subsequent procedures in the thoracoabdominal aorta. Mid-term survival was also greater in the stented patients.

Keywords: acute type I aortic dissection; aortic arch surgery; aortic dissection; stenting; survival.

MeSH terms

  • Aneurysm, Dissecting* / diagnosis
  • Aneurysm, Dissecting* / surgery
  • Aorta, Thoracic* / diagnostic imaging
  • Aorta, Thoracic* / surgery
  • Aortic Aneurysm, Thoracic* / diagnosis
  • Aortic Aneurysm, Thoracic* / surgery
  • Blood Vessel Prosthesis
  • Blood Vessel Prosthesis Implantation* / adverse effects
  • Blood Vessel Prosthesis Implantation* / instrumentation
  • Blood Vessel Prosthesis Implantation* / methods
  • Blood Vessel Prosthesis Implantation* / mortality
  • Endovascular Procedures / methods
  • Female
  • Humans
  • Male
  • Middle Aged
  • Outcome and Process Assessment, Health Care
  • Postoperative Complications* / diagnosis
  • Postoperative Complications* / epidemiology
  • Postoperative Complications* / etiology
  • Retrospective Studies
  • Stents / statistics & numerical data*
  • Survival Analysis
  • Tomography, X-Ray Computed / methods
  • Treatment Outcome
  • United States