Abstract | BACKGROUND AND AIM: Concomitant endovascular stent grafting of the descending thoracic aorta during open repair for acute DeBakey I aortic dissection can be performed in patients with extensive dissection and malperfusion. We analyzed the effects of this strategy on distal aortic remodeling. METHODS: From 2006-2014, acute DeBakey I dissection patients without primary aortic arch tear undergoing open distal hemiarch reconstruction (Standard group) versus those undergoing hemiarch with descending thoracic aorta (DTA) thoracic endovascular aortic repair ( TEVAR group) were retrospectively reviewed. We studied aortic remodeling only in patients with three-dimensional computed tomography scans available at 1 and 12 months following surgery (Standard group n = 26; Stent group n = 21). RESULTS: At 1 month, abdominal aortic diameters were similar, but true lumen (TL) and true lumen to total diameter ratios (TL index [TLI]) in the DTA were significantly improved in the TEVAR group (P < 0.05). Mean number of fenestrations were similar (1.8 ± 1.5 vs. 2.4 ± 1.9, P = 0.32). At 12 months, DTA true lumen and TLI remained significantly improved in the TEVAR group at all locations (P < 0.01). This translated to increased complete false lumen thrombosis rates in the thoracic aorta (83% vs. 32%, P = 0.01) in the TEVAR group. In the Standard group, DTA true lumen diameter and TL index were significantly decreased at 12 months compared to 1 month time period (P < 0.05). In the TEVAR group, DTA true lumen diameters and TLI were significantly improved at 12 months (P < 0.05). CONCLUSIONS: Antegrade TEVAR during open repair for DeBakey I dissection improves DTA remodeling by increasing true lumen diameter without enlargement of the total aortic diameter and by promoting false lumen thrombosis.
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Authors | Ibrahim Sultan, Tyler J Wallen, Andreas Habertheuer, Mary Siki, George J Arnaoutakis, Joseph Bavaria, Wilson Y Szeto, Rita Milewski, Prashanth Vallabhajosyula |
Journal | Journal of cardiac surgery
(J Card Surg)
Vol. 32
Issue 9
Pg. 581-592
(Sep 2017)
ISSN: 1540-8191 [Electronic] United States |
PMID | 28795434
(Publication Type: Journal Article)
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Copyright | © 2017 Wiley Periodicals, Inc. |
Topics |
- Acute Disease
- Aged
- Aortic Dissection
(surgery)
- Aorta
(pathology)
- Aorta, Thoracic
(surgery)
- Aortic Aneurysm
(surgery)
- Endovascular Procedures
(methods)
- Female
- Humans
- Male
- Middle Aged
- Plastic Surgery Procedures
(methods)
- Retrospective Studies
- Stents
- Treatment Outcome
- Vascular Remodeling
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