International Society For Minimally Invasive Cardiothoracic Surgery

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Midterm Results of Thoracic Endovascular Aortic Repair For Uncomlicated Type B Aortic Dissection
Akitoshi Takazawa, MD, Toshihisa Asakura, MD, Akihiro Yoshitake, MD, Chiho Tokunaga, MD, Masato Tochii, MD, Atsushi Iguchi, MD, Hiroyuki Nakajima, MD.
Saitama medical university International medical center, Hidaka city, Japan.

BACKGROUND
In recent years, the thoracic endovascular aortic repair(TEVAR) is the optimal therapy for complicated type B aortic dissection. In uncomplicated cases, a medical treatment is the first choice. It is unclear which uncomplicated type B aortic dissection(UTBAD) patients should undergo TEVAR interm of its outcomes and thoracic descending aortic remodeling(REM). This study examined the midterm results and aortic remodeling after TEVAR for patients with UTBAD.

METHODS
From March 2013 to August 2018, we retrospectively reviewed 30 consecutive patients underwent TEVAR for UTBAD. We divided two groups; R group was obtained aortic remodeling and N group was not obtained aortic remodeling. Group R was 14 patients and group N was 16 patients. Mean follow up period was 2.7 years.

RESULTS
All patients were alive and all maneuver were succeeded. There are no complications such as cerebral infarction, the spinal cord paralysis in the all cases. The significant difference was seen in the interval between onset and operation(R:176 days, N:965 days: p<0.01), the aortic diameter(R:45mm, N:51mm, p=0.04) and the residual flow of abdominal false lumen(R:7, N:16, p<0.01). 7 patients were performed in subacute phase in group R and all patients in chronic phase in group N. In group N, retrograde type A dissection (RTAD) was seen in two patients. Re-intervention was performed one patient in group R and four in group N.

CONCLUSIONS
The midterm results in our study showed that TEVAR for UTBAD was safe and effective. RTAD and reintervention was seen in group N. TEVAR for UTBAD should be performed in subacute phase for the aortic remodeling. The abdominal aortic false lumen remains patent and should be carefully followed for long-term aneurysm formation.


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