JTCVS open · 2025
Surgical experience and long-term outcomes of retrograde type A aortic dissection after thoracic endovascular aortic repair.
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Ji Yumeng, Zhang Kai, Zhou Chenyu, Gao Wei, Hou Bin, Wang Ji, Xu Kai, Gao Shiqi, Qiu Juntao, Yu Cuntao
Аннотация
OBJECTIVE: To evaluate and summarize the long-term outcomes of surgical treatment in patients who developed retrograde type A aortic dissection (RTAD) following thoracic endovascular aortic repair (TEVAR).
METHODS: Between January 2010 and June 2023, patients who underwent surgical treatment for RTAD following TEVAR at Fuwai Hospital were selected for clinical data collection and long-term follow-up. Both early postoperative outcomes and long-term follow-up results were evaluated.
RESULTS: Among 67 patients who underwent surgical treatment for RTAD following TEVAR (33 acute dissections, 34 chronic dissections), 57 (85.1%) received total arch replacement (TAR) combined with frozen elephant trunk (FET). Entry tears were located predominantly in the aortic arch (73.1%). Early mortality was 6.0% (n = 4). The 1-year and 5-year survival rates were 95.1% and 90.5%, respectively. Cardiovascular reintervention rates were 16.4% at 1 year and 23.8% at 5 years. During follow-up, 5-year survival rates were similar in the acute and chronic dissection groups (90.9% vs 85.5%; P = .9). The TAR with FET group was associated with a significantly lower incidence of composite endpoint events compared to other surgical approaches (28.1% vs 70%; P = .034), with Cox analysis showing a 66% risk reduction for endpoint events in the TAR with FET group.
CONCLUSIONS: Surgical management of RTAD after TEVAR shows comparable outcomes between acute and chronic cases. TAR with FET was associated with favorable long-term results in our cohort, suggesting that it may be a reasonable approach to consider for these patients. Vigilant follow-up remains essential as RTAD risk persists well beyond the conventional 1-month post-TEVAR period.
METHODS: Between January 2010 and June 2023, patients who underwent surgical treatment for RTAD following TEVAR at Fuwai Hospital were selected for clinical data collection and long-term follow-up. Both early postoperative outcomes and long-term follow-up results were evaluated.
RESULTS: Among 67 patients who underwent surgical treatment for RTAD following TEVAR (33 acute dissections, 34 chronic dissections), 57 (85.1%) received total arch replacement (TAR) combined with frozen elephant trunk (FET). Entry tears were located predominantly in the aortic arch (73.1%). Early mortality was 6.0% (n = 4). The 1-year and 5-year survival rates were 95.1% and 90.5%, respectively. Cardiovascular reintervention rates were 16.4% at 1 year and 23.8% at 5 years. During follow-up, 5-year survival rates were similar in the acute and chronic dissection groups (90.9% vs 85.5%; P = .9). The TAR with FET group was associated with a significantly lower incidence of composite endpoint events compared to other surgical approaches (28.1% vs 70%; P = .034), with Cox analysis showing a 66% risk reduction for endpoint events in the TAR with FET group.
CONCLUSIONS: Surgical management of RTAD after TEVAR shows comparable outcomes between acute and chronic cases. TAR with FET was associated with favorable long-term results in our cohort, suggesting that it may be a reasonable approach to consider for these patients. Vigilant follow-up remains essential as RTAD risk persists well beyond the conventional 1-month post-TEVAR period.