O05 – Zhongze Cao – Erasmus MC

Short-term and 5-year outcomes after Zone 2 thoracic endovascular aortic repair for acute type B aortic dissection

Samenvatting:
Introduction: The benefits of left subclavian artery (LSA) revascularization during thoracic endovascular aortic repair (TEVAR) for patients with acute type B aortic dissection (aTBAD) remain controversial. This study aimed to evaluate the impact of LSA coverage with or without revascularization after Zone 2 TEVAR on survival and neurologic outcomes in patients with aTBAD.

Method: Consecutive aTBAD patients undergoing urgent Zone 2 TEVAR between 2010 and 2020 were included. LSA was predominantly covered without revascularization before 2016. From 2016 on, patients were revascularized mainly by fenestrations. But chimney stenting and carotid-subclavian bypass were also applied. Outcomes of interest during follow-up were incidence of cerebrovascular accident (CVA) and freedom from major adverse cardiovascular events (MACE).

Results: The final analysis included 253 aTBAD patients receiving Zone 2 TEVAR, 135 without LSA revascularization (mean age 49.27±9.75 years), and 118 with revascularization (mean age 49.42±10.54 years, p = .907). All procedures were performed between 3 and 14 days after symptom onset. Intergroup balance was achieved after weighting. After LSA revascularization, incidences of 30-day mortality (1/118 vs 2/135; p = .568), and early CVA (1/118 vs 1/135; p = .931) were comparable between groups. Median follow-up duration was 127 months (IQR 105- 142) without revascularization and 69.5 months (IQR, 50-79) after revascularization. At 5-year follow-up, estimated CVA incidence was 4.8% after revascularization and 6.1% without revascularization (p = .34). Freedom from MACE was 91.2% after revascularization and 89.1% without revascularization (p = .55).

Conclusions: LSA revascularization during Zone 2 TEVAR does not increase risks for perioperative morbidities. CVA rates and MACE-free survival were statistically comparable between groups at 5-year follow-up. Future studies including patients from different parts of the world, with larger cohorts, and improved study design are needed to further determine the impact of LSA revascularization after Zone 2 TEVAR for aTBAD.