Abstract
Objective
Thoracic endovascular aortic repair is the standard of care for acute complicated
type B aortic dissections, but long-term single-device outcomes are limited.
Methods
Fifty patients were treated with the Valiant Captivia thoracic stent graft (Medtronic
Inc, Santa Rosa, Calif) for acute complicated type B aortic dissections in this prospective,
nonrandomized Dissection Trial. All-cause mortality, secondary procedures, and serious
adverse events were assessed, and a core lab evaluated images for aortic remodeling.
Results
Compliance for both clinical and imaging follow-up was 78% (18 out of 23) for the
available patients at 5 years. Notable baseline characteristics were 86% of patients
(43 out of 50) had malperfusion, 20% (10 out of 50) had ruptures, and 94% (46 out
of 49) had DeBakey class IIIB dissections. The 5-year freedom from dissection-related
mortality, secondary procedures related to the dissection, and endoleaks was 83%,
86%, and 85%, respectively. After 5 years, 89% of patients (16 out of 18) had a completely
thrombosed false lumen in the stented segment of the aorta and the true lumen diameter
over the length of stent graft was stable or increased for 94% of patients (16 out
of 17) while the false lumen diameter was stable or decreased in 77% (13 out of 17)
after 5 years.
Conclusions
In the Dissection Trial, patients experienced positive and sustained measures of aortic
remodeling. Survival outcomes, need for secondary procedures, and adverse event rates
were consistent with previous thoracic endovascular aortic repair studies. Although
limitations exist with the follow-up compliance, the Valiant Captivia thoracic stent
graft system was effective in the long-term management of acute complicated type B
aortic dissections in this patient population with a challenging condition.
Graphical abstract
Graphical Abstract
Key Words
Abbreviations and Acronyms:
ACM (all-cause mortality), INSTEAD-XL (Investigation of Stent Grafts in Aortic Dissection with extended length of follow-up), IRAD (International Registry of Acute Aortic Dissection), LSA (left subclavian artery), PVD (peripheral vascular disease), RTAD (retrograde type A dissection), TBAD (type B aortic dissection), TEVAR (thoracic endovascular aortic repair)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The Journal of Thoracic and Cardiovascular SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Complicated acute type B aortic dissection: midterm results of emergency endovascular stent-grafting.J Thorac Cardiovasc Surg. 2008; 136: 424-430
- Acute type B aortic dissection: insights from the international registry of acute aortic dissection.Ann Cardiothorac Surg. 2014; 3: 368-374
- Mid-term outcomes and aortic remodelling after thoracic endovascular repair for acute, subacute, and chronic aortic dissection: the VIRTUE registry.Eur J Vasc Endovasc Surg. 2014; 48: 363-371
- Progress in management of malperfusion syndrome from type B dissections.J Vasc Surg. 2013; 57: 1283-1290
- Long-term survival in patients presenting with type B acute aortic dissection: insights from the international registry of acute aortic dissection.Circulation. 2006; 114: 2226-2231
- Midterm results after endovascular treatment of acute, complicated type B aortic dissection.Ann Thorac Surg. 2010; 90: 1444-1448
- Survival after endovascular therapy in patients with type B aortic dissection: a report from the international registry of acute aortic dissection (IRAD).JACC Cardiovasc Interv. 2013; 6: 876-882
- Insights from the international registry of acute aortic dissection: a 20-year experience of collaborative clinical research.Circulation. 2018; 137: 1846-1860
- Thoracic endovascular aortic repair (TEVAR) for the treatment of aortic diseases: a position statement from the European Association for Cardio-Thoracic Surgery (EACTS) and the European Society of Cardiology (ESC), in collaboration with the European Association of Percutaneous Cardiovascular Interventions (EAPCI).Eur Heart J. 2012; 33: 1558-1563
- Partial thrombosis of the false lumen in patients with acute type B aortic dissection.N Engl J Med. 2007; 357: 349-359
- Outcomes of thoracic endovascular aortic repair in acute Type B aortic dissection: results from the Valiant United States investigational device exemption study.Ann Thorac Surg. 2015; 100: 802-808
- Early outcomes of thoracic endovascular stent-graft repair for acute complicated type B dissection using the Gore TAG endoprosthesis.Ann Vasc Surg. 2008; 22: 742-749
- Valiant thoracic stent-graft deployed with the new Captivia delivery system: procedural and 30-day results of the Valiant Captivia registry.J Endovasc Ther. 2012; 19: 213-225
- One-year results of thoracic endovascular aortic repair for blunt thoracic aortic injury (RESCUE trial).J Thorac Cardiovasc Surg. 2015; 149: 155-161.e4
- Endovascular repair in acute complicated type B aortic dissection: 3-year results from the Valiant US investigational device exemption study.Korean J Thorac Cardiovasc Surg. 2017; 50: 137-143
- Challenging current conservative management of uncomplicated acute type B aortic dissections.EJVES Short Rep. 2018; 39: 37-39
- Hypertensive emergency in aortic dissection and thoracic aortic aneurysm—a review of management.Pharmaceuticals (Basel). 2009; 2: 66-76
- Management of acute aortic dissections.Ann Thorac Surg. 1970; 10: 237-247
- Left subclavian arterial coverage and stroke during thoracic aortic endografting: a systematic review.Ann Thorac Surg. 2016; 101: 381-389
- Endovascular repair of type B aortic dissection: long-term results of the randomized investigation of stent grafts in aortic dissection trial.Circ Cardiovasc Interv. 2013; 6: 407-416
- Early and long-term outcome after thoracic endovascular aortic repair (TEVAR) for acute complicated type B aortic dissection.Eur J Vasc Endovasc Surg. 2011; 41: 318-323
- Stent-graft induced new entry tears after type B aortic dissection: how to treat and how to prevent?.J Cardiovasc Surg (Torino). 2018; 59: 789-796
- Incidence and risk factors for retrograde type A dissection and stent graft-induced new entry after thoracic endovascular aortic repair.J Vasc Surg. 2018; 67: 1026-1033.e2
- Pivotal results for the Valiant Navion stent graft system in the Valiant EVO global clinical trial.J Vasc Surg. 2019; 70: 1399-1408.e1
- False lumen patency as a predictor of late outcome in aortic dissection.Am J Cardiol. 2001; 87: 1378-1382
- True-lumen collapse in aortic dissection: part I. Evaluation of causative factors in phantoms with pulsatile flow.Radiology. 2000; 214: 87-98
- A morphologic study of chronic type B aortic dissections and aneurysms after thoracic endovascular stent grafting.J Vasc Surg. 2012; 55: 1268-1275
- Minimum 10-year follow-up of endovascular repair for acute traumatic transection of the thoracic aorta.J Thorac Cardiovasc Surg. 2015; 149: 825-829
- Aortic elongation part I: the normal aortic ageing process.Heart. 2018; 104: 1772-1777
- Thoracic aortic aneurysm clinically pertinent controversies and uncertainties.J Am Coll Cardiol. 2010; 55: 841-857
Article Info
Publication History
Published online: May 12, 2020
Accepted:
March 16,
2020
Received in revised form:
March 5,
2020
Received:
May 1,
2019
Footnotes
The Evaluation of the Clinical Performance of the Valiant Thoracic Stent Graft with the Captivia Delivery System for the Treatment of Acute, Complicated Type B Aortic Dissections (NCT01114724) was funded by Medtronic, Inc , although funding was not provided specifically for this analysis.
Identification
Copyright
© 2020 Published by Elsevier Inc. on behalf of The American Association for Thoracic Surgery
ScienceDirect
Access this article on ScienceDirectLinked Article
- Commentary: Are the early benefits of thoracic endovascular aortic repair in complicated type B dissection durable through time?The Journal of Thoracic and Cardiovascular SurgeryVol. 163Issue 2
- PreviewThe introduction of thoracic endovascular aortic repair (TEVAR) procedures have revolutionized the treatment of complicated type B aortic dissection. Perioperative mortality rates have declined from 30% to 50% for a classic open repair to 10% in the TEVAR era.1 Although the benefits of TEVAR to decrease early morbidity and mortality are indisputable, data on late outcomes remain limited. Bavaria and colleagues2 report good clinical outcomes at 5 years in a multicenter nonrandomized trial of 50 patients with acute type B aortic dissection with malperfusion treated with the Valiant Captivia device (Medtronic, Minneapolis, Minn).
- Full-Text
- Preview
- Commentary: It’s not how you drive—it’s how you arrive!The Journal of Thoracic and Cardiovascular SurgeryVol. 163Issue 2
- PreviewAlthough acute type A aortic dissection is a life-threatening event, dissection affecting the distal aorta—type B aortic dissection—is far less lethal in most circumstances. The traditional treatment paradigm for acute type B aortic dissection (ATBAD) stresses medical management for the vast majority of patients, who are without serious complication. However, for the few patients with ATBAD and complications (eg, malperfusion, rupture, rapid aortic expansion, severe pain, and other factors), action must be taken to avoid catastrophe.
- Full-Text
- Preview
