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ORIGINAL RESEARCH article

Front. Cardiovasc. Med.
Sec. Aortic Surgery and Endovascular Repair Archive
Volume 11 - 2024 | doi: 10.3389/fcvm.2024.1442800

Safe and favorable prognosis of thoracic endovascular aortic repair for the low-risk patients with non-acute type B aortic dissection

Provisionally accepted
Ken Nakamura Ken Nakamura 1,2,3*Kimihiro Kobayashi Kimihiro Kobayashi 3Shingo Nakai Shingo Nakai 3Ri SHO Ri SHO 3Shusuke Arai Shusuke Arai 2Ai Ishizawa Ai Ishizawa 3Daisuke Watanabe Daisuke Watanabe 3Shuto Hirooka Shuto Hirooka 3Eiichi Ohba Eiichi Ohba 3Masahiro Mizumoto Masahiro Mizumoto 3Yoshinori Kuroda Yoshinori Kuroda 3Cholsu Kim Cholsu Kim 2Hideaki Uchino Hideaki Uchino 2Takao Shimanuki Takao Shimanuki 2Tetsuro Uchida Tetsuro Uchida 3
  • 1 Cleveland Clinic, Cleveland, United States
  • 2 Nihonkai General Hospital, Sakata, Yamagata, Japan
  • 3 Yamagata University, Yamagata, Yamagata, Japan

The final, formatted version of the article will be published soon.

    Objective: Preemptive thoracic endovascular aortic repair (TEVAR) has the potential to improve the prognosis of Stanford type B aortic dissection (TBAD), however it is important to determine whether it could be safely performed as a prophylactic treatment. This study aimed to determine the short-and long-term outcomes of preemptive TEVAR for uncomplicated TBAD with a small aortic aneurysm.We analyzed 212 patients with medically treated uncomplicated subacute TBAD between July 2004 and October 2019 in two Japanese academic centers. The short-and long-term prognosis of patients who underwent preemptive TEVAR and the changes in aortic diameter over time after TEVAR were analyzed. Aorta-related complications, aortic-related death and postoperative complications were recorded and analyzed. Analysis was performed on an intension-to-treat basis.Results: During follow-up, patients were divided into two groups: optimal medical treatment (OMT; n=185 [87%]) and preemptive TEVAR (n=27 [13%]).In all cases, aortic enlargement was the reason for therapeutic intervention in the preemptive TEVAR group. Propensity score matching yielded a cohort of 27 control patients with OMT (group A) and 27 patients who underwent preemptive 4 4 TEVAR (group B). Preoperative characteristics were similar between groups. In group B, only one patient developed type A dissection at a late stage and died from aortic rupture. Freedom from aortic-related death at 1/5/10 years was 100%/92%/92% in group B. Overall growth (mm/year) of max aorta was significantly smaller in the TEVAR group than in the control group (-3.7 ± 2.9 vs 0.4 ± 5.6, p<0.01), and the diameter of the false lumen was reduced (-8 ± 4.8 vs -1.3 ± 8.0, p<0.001).Conclusions: Short-and long-term outcomes of TEVAR for uncomplicated TBAD with a small aortic aneurysm were excellent, with few postoperative complications. After TEVAR, aortic remodeling was observed in the short term, suggesting that it may contribute to the prevention of aortic-related death due to rupture.

    Keywords: uncomplicated Stanford type B aortic dissection, conservative treatment, preemptive thoracic endovascular aortic repair, Aortic Aneurysm, aortic remodeling chronic obstructive pulmonary disease HTN: hypertension NPPV: Noninvasive Positive Pressure Ventilation

    Received: 02 Jun 2024; Accepted: 14 Sep 2024.

    Copyright: © 2024 Nakamura, Kobayashi, Nakai, SHO, Arai, Ishizawa, Watanabe, Hirooka, Ohba, Mizumoto, Kuroda, Kim, Uchino, Shimanuki and Uchida. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Ken Nakamura, Cleveland Clinic, Cleveland, United States

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.