Catheter-based treatment of the dissected ascending aorta: a systematic review

Eur J Cardiothorac Surg. 2021 Jan 4;59(1):80-91. doi: 10.1093/ejcts/ezaa238.

Abstract

Objectives: Type A aortic dissection requires immediate surgical repair. Despite improvements in surgery and anaesthesia, there is still a considerable risk when high-risk patients are concerned. Less invasive endovascular treatments are under evaluation. We investigated the current status of catheter-based treatment for type A aortic dissection with the entry tear located in the ascending aorta.

Methods: A PubMed search was supplemented by searching through bibliographies and key articles. Demographics, risk score, stent graft detail, access route, mortality, cause of death, complications, reinterventions and follow-up data were extracted and analysed.

Results: Thirty-one articles (7 retrospective reports; 24 case reports/series) were included in the study. In total, 104 patients (mean age 71 ± 14 years) received endovascular treatment for acute (63) or chronic (41) type A dissection. A history of a major cardiac or aortic operation was present in 29 patients. The mean EuroSCORE II was 30 ± 20 in 4 reports. A total of 114 stent grafts were implanted: 'off-the-shelf', 65/114; custom made, 12/114; and modified, 7/114. Hospital complications included intraprocedural conversion to open surgery (2/104), stroke (2/104), coronary stenting (2/104), early endoleak (9/104) and repeat aortic endovascular treatment for endoleak (5/104). Hospital mortality was 10% (intraoperative death 2/104). Mean duration of follow-up time was 21 ± 21 months (range 1-81 months); follow-up data were available for 86 patients: 10 patients died of non-aortic-related causes; reintervention for aortic disease (endovascular repair or open surgery) was performed in 8 patients.

Conclusions: Catheter-based ascending aorta repair for type A aortic dissection with the entry tear in the ascending aorta can be considered in carefully selected high-risk patients. Further analysis and specifically designed devices are required.

Keywords: Ascending aorta dissection; Catheter-based techniques; Endovascular aorta repair.

Publication types

  • Research Support, Non-U.S. Gov't
  • Systematic Review

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aorta / surgery
  • Aorta, Thoracic / surgery
  • Aortic Aneurysm, Thoracic* / surgery
  • Blood Vessel Prosthesis Implantation* / adverse effects
  • Catheters
  • Endovascular Procedures* / adverse effects
  • Humans
  • Middle Aged
  • Retrospective Studies
  • Stents
  • Treatment Outcome