A Multicenter Clinical Trial on the Five-Year Outcomes Following Treatment of Acute, Complicated Type B Aortic Dissection With a Conformable Stent Graft.

BACKGROUND: Thoracic endovascular aortic repair (TEVAR) has become the treatment of choice for acute, complicated type B aortic dissections. The purpose of this study was to evaluate the 5-year outcomes of the GORE thoracic aortic graft (TAG) 08-01 study on TEVAR for acute, complicated type B aortic dissections using the GORE conformable TAG thoracic endoprosthesis (CTAG) and to establish if late aortic complications are avoided and remodeling is sustained.

METHODS: From January 2010 to February 2017, 50 patients with acute, complicated type B aortic dissections were enrolled from 26 sites in the United States in this prospective, nonrandomized study. Patients underwent follow-up assessments postprocedure, at 1 month, 6 months, 1 year, and then yearly through 5 years. Device-related events, false lumen thrombosis, and aortic remodeling were assessed from computed tomography (CT) scans by a core laboratory.

RESULTS: The all-cause mortality rate through 5 years was 26%. 4% of patients experienced late (>30 day) deaths that were attributable to aortic pathology. Secondary interventions were required in 22% of patients. In 87% of patients, complete false lumen thrombosis in the portion of the false lumen parallel to the stent-graft was observed. There was a significant 11 mm increase in the maximum true lumen diameter (P < 0.0001) and a 22 mm decrease in the maximum false lumen diameter (P < 0.0001) over 5 years. True lumen area was also increased by 221 mm2 (P = 0.0003) over 5 years. There was no significant change in the false lumen area. There were no associations observed between patient outcomes and pretreatment indication for treatment (i.e., rupture with or without malperfusion or malperfusion alone).

CONCLUSIONS: Treatment of patients with advanced pathophysiology with the CTAG device resulted in favorable long-term clinical and anatomic outcomes. Complete thrombosis of the false lumen and positive aortic remodeling was sustained throughout the study. The low rate of late aortic events observed in this study demonstrates the safety, effectiveness, and the long-term durability of the CTAG device.