Abstract 19899: TEVAR in Acute Type B Aortic Dissection: Insights from the International Registry of Acute Aortic Dissection (IRAD), Interventional Cohort (IVC)
OBJECTIVE: Thoracic endovascular aortic repair (TEVAR) has evolved in to a common therapy for complicated acute type B aortic dissection (ABAD). Recently, the International Registry of Acute Aortic Dissection (IRAD) database was expanded with an interventional cohort (IVC) to further examine details of interventional and surgical treatments.
METHODS: ABAD patients treated with TEVAR enrolled in IRAD IVC were studied (n=157). Mean age at intervention was 62±13y. Intra-procedural details were analysed and related to in-hospital outcomes. Indications for TEVAR were identified in 63%, including malperfusion (41%), periaortic hematoma (18%), hypotension/shock (2%), refractory/recurrent pain and hypertension (38%), and aortic diameter > 5.0 cm (4%).
RESULTS: addition to TEVAR, visceral artery stenting (including celiac, SMA and renal artery) was required in 22%. This cohort was more likely to manifest malperfusion (50 vs 14%, p=.001) and acute renal failure (46 vs 8%, p<.001) postoperatively. The number of aortic stent grafts (sgs), independent from mean sg length, was associated with increased early mortality (median 2.0 vs 1.0 sgs in those who died vs who survived, p=.066), malperfusion (2.0 vs 1.0 sgs with vs without malperfusion, p=.036), and extension of dissection (3.0 vs 2.0 sgs with vs without extension, p=.030). Larger proximal (39.0 vs 34.0 mm, p=.001) and distal sg diameters (40.0 vs 34.0 mm, p=.009) were associated with higher early mortality. Patients with longer TEVAR aortic coverage were more likely to have postoperative limb ischemia (260 vs 200 mm, p=.011) and extension of dissection (410 vs 200 mm, p=.041). Overall early mortality was 12%; patients died from multi-organ failure (26%), rupture (21%), neurologic (11%), visceral ischemia (11%), cardiac (11%), or other complications (21%). In-hospital mortality did not differ between TEVAR patients with and without additional visceral stenting (13 vs 10%, p=.704).
CONCLUSIONS: The extent of disease and complexity of the procedure, indicated by several patient- and TEVAR specific details, dictates adverse early outcomes in ABAD after TEVAR. Knowledge of those interventional details may be of importance in the perioperative assessment of patients presenting with ABAD.
Author Disclosures: G.H. van Bogerijen: None. H.J. Patel: None. G.R. Upchurch: None. D.G. Montgomery: None. C.A. Nienaber: None. E.M. Isselbacher: None. R. Fattori: None. N.D. Desai: None. J.E. Bavaria: None. M. Di Eusanio: None. T.M. Sundt: None. T.G. Gleason: None. D.M. Williams: None. K.A. Eagle: None. S. Trimarchi: None.
- © 2014 by American Heart Association, Inc.