Skip to main content

Advertisement

SpringerLink
Log in

Surgical Treatment for Type A Aortic Dissection after Endovascular Aortic Repair: A 12-year, Single-Center Study

  • Original Article
  • Published:
Cardiovascular Drugs and Therapy Aims and scope Submit manuscript

Abstract

Objective

This study aims to investigate the clinical manifestations, operative techniques, and outcomes of patients who undergo open repair after thoracic endovascular aortic repair (TEVAR).

Methods

From January 2010 to June 2022, 113 consecutive type A aortic dissection (TAAD) patients underwent secondary open operation after TEVAR at our institution, and the median interval from primary intervention to open surgery was 12 (1.9–48.0) months. We divided the patients into two groups (RTAD (retrograde type A dissection) group, N = 56; PNAD (proximal new aortic dissection) group, N = 57) according to their anatomical features. Survival analysis during the follow-up was evaluated using a Kaplan–Meier survival curve and a log-rank test.

Results

The 30-day mortality was 6.2% (7/113), the median follow-up period was 31.7 (IQR 14.7–65.6) months, and the overall survival at 1 year, 5 years, and 10 years was 88.5%, 88.5%, and 87.6%, respectively. Fourteen deaths occurred during the follow-up, but there were no late aorta-related deaths. Three patients underwent total thoracoabdominal aortic replacement 1 year after a second open operation. The RTAD group had a smaller ascending aorta size (42.5 ± 7.7 mm vs 48.4 ± 11.4 mm; P < .01) and a closer proximal landing zone (P < .01) compared to the PNAD group. However, there were no differences in survival between the two groups.

Conclusions

TAAD can present as an early or a late complication after TEVAR due to stent-grafting-related issues or disease progression. Open operation can be performed to treat TAAD, and this has acceptable early and mid-term outcomes. Follow-up should become mandatory for patients after TEVAR because these patients are at increased risk for TAAD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Availability of Data and Materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

TEVAR :

Thoracic endovascular aortic repair

TAAD :

Type A aortic dissection

TBAD :

Type B aortic dissection

RTAD :

Retrograde type A dissection

PNAD :

Proximal new aortic dissection

CTA :

Computed tomography angiography

TAR :

Total arch replacement

FET :

Frozen elephant trunk

HAR :

Hemiarch replacement

CPB :

Cardiopulmonary bypass

HCA :

Hypothermic circulatory arrest

TAWSS :

Time-averaged wall shear stress

CFD :

Computational fluid dynamics

References

  1. Dake MD, Miller DC, Semba CP, Mitchell RS, Walker PJ, Liddell RP. Transluminal placement of endovascular stent-grafts for the treatment of descending thoracic aortic aneurysms. N Engl J Med. 1994;331(26):1729–34.

    Article  CAS  PubMed  Google Scholar 

  2. Riambau V, Böckler D, Brunkwall J, et al. Editor's choice - Management of descending thoracic aorta diseases: clinical practice guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg: Off J Eur Soc Vasc Surg. 2017;53(1). https://doi.org/10.1016/j.ejvs.2016.06.005.

  3. Rudarakanchana N, Jenkins MP. Hybrid and total endovascular repair of the aortic arch. Br J Surg. 2018;105(4):315–27. https://doi.org/10.1002/bjs.10713.

    Article  CAS  PubMed  Google Scholar 

  4. Czerny M, Pacini D, Aboyans V, et al. Current options and recommendations for the use of thoracic endovascular aortic repair in acute and chronic thoracic aortic disease: an expert consensus document of the European Society for Cardiology (ESC) Working Group of Cardiovascular Surgery, the ESC Working Group on Aorta and Peripheral Vascular Diseases, the European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the ESC and the European Association for Cardio-Thoracic Surgery (EACTS). Eur J Cardiothorac Surg. 2021;59(1):65–73. https://doi.org/10.1093/ejcts/ezaa268.

    Article  PubMed  Google Scholar 

  5. Kpodonu J, Preventza O, Ramaiah VG, et al. Retrograde type A dissection after endovascular stenting of the descending thoracic aorta. Is the risk real? Eur J Cardiothorac Surg. 2008;33(6):1014–1018. https://doi.org/10.1016/j.ejcts.2008.03.024.

  6. Eggebrecht H, Thompson M, Rousseau H, et al. Retrograde ascending aortic dissection during or after thoracic aortic stent graft placement: insight from the European registry on endovascular aortic repair complications. Circulation. 2009;120(11 Suppl):S276–81. https://doi.org/10.1161/CIRCULATIONAHA.108.835926.

    Article  PubMed  Google Scholar 

  7. Dong ZH, Fu WG, Wang YQ, et al. Retrograde type A aortic dissection after endovascular stent graft placement for treatment of type B dissection. Circulation. 2009;119(5):735–41. https://doi.org/10.1161/CIRCULATIONAHA.107.759076.

    Article  PubMed  Google Scholar 

  8. Wang L, Zhao Y, Zhang W, et al. Retrograde type A aortic dissection after thoracic endovascular aortic repair: incidence, time trends and risk factors. Semin Thorac Cardiovasc Surg. 2021;33(3):639–53. https://doi.org/10.1053/j.semtcvs.2020.11.010.

    Article  PubMed  Google Scholar 

  9. Li B, Pan X-D, Ma W-G, et al. Stented elephant trunk technique for retrograde type A aortic dissection after endovascular stent graft repair. Ann Thorac Surg. 2014;97(2):596–602. https://doi.org/10.1016/j.athoracsur.2013.09.033.

    Article  MathSciNet  PubMed  Google Scholar 

  10. Dun Y, Shi Y, Guo H, et al. Secondary open arch operation after prior thoracic endovascular aortic repair. Ann Thorac Surg. 2021;111(5):1545–53. https://doi.org/10.1016/j.athoracsur.2020.07.026.

    Article  PubMed  Google Scholar 

  11. Scheinert D, Krankenberg H, Schmidt A, et al. Endoluminal stent-graft placement for acute rupture of the descending thoracic aorta. Eur Heart J. 2004;25(8):694–700.

    Article  CAS  PubMed  Google Scholar 

  12. World Medical Association Declaration of Helsinki. Ethical principles for medical research involving human subjects. Bull World Health Organ. 2001;79(4):373–4.

    Google Scholar 

  13. Fillinger MF, Greenberg RK, McKinsey JF, Chaikof EL. Reporting standards for thoracic endovascular aortic repair (TEVAR). J Vasc Surg. 2010;52(4). https://doi.org/10.1016/j.jvs.2010.07.008.

  14. Dake MD, Kato N, Mitchell RS, et al. Endovascular stent-graft placement for the treatment of acute aortic dissection. N Engl J Med. 1999;340(20):1546–52.

    Article  CAS  PubMed  Google Scholar 

  15. Khoynezhad A, White RA. Pathogenesis and management of retrograde type A aortic dissection after thoracic endovascular aortic repair. Ann Vasc Surg. 2013;27(8):1201–6. https://doi.org/10.1016/j.avsg.2012.08.010.

    Article  PubMed  Google Scholar 

  16. Canaud L, Ozdemir BA, Patterson BO, Holt PJE, Loftus IM, Thompson MM. Retrograde aortic dissection after thoracic endovascular aortic repair. Ann Surg. 2014;260(2):389–95. https://doi.org/10.1097/SLA.0000000000000585.

    Article  PubMed  Google Scholar 

  17. Pellenc Q, Girault A, Roussel A, et al. Optimising aortic endovascular repair in patientswith Marfan syndrome. Eur J Vasc Endovasc Surg: Off J Eur Soc Vasc Surg. 2020;59(4):577–85. https://doi.org/10.1016/j.ejvs.2019.09.501.

    Article  Google Scholar 

  18. Zhang S, Chen Y, Lu Q. Retrograde type A aortic dissection complicating endovascular therapy of type B aortic dissection and descending thoracic aneurysm disease. Curr Opin Cardiol. 2018;33(6):581–6. https://doi.org/10.1097/HCO.0000000000000567.

    Article  PubMed  Google Scholar 

  19. Appoo JJ, Herget EJ, Pozeg ZI, et al. Midterm results of endovascular stent grafts in the proximal aortic arch (zone 0): an imaging perspective. Can J Cardiol. 2015;31(6):731–7. https://doi.org/10.1016/j.cjca.2014.12.023.

    Article  PubMed  Google Scholar 

  20. Williams JB, Andersen ND, Bhattacharya SD, et al. Retrograde ascending aortic dissection as an early complication of thoracic endovascular aortic repair. J Vasc Surg. 2012;55(5):1255–62. https://doi.org/10.1016/j.jvs.2011.11.063.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Vallabhajosyula P, Szeto W, Desai N, Bavaria JE. Type I and Type II hybrid aortic arch replacement: postoperative and mid-term outcome analysis. Ann Cardiothorac Surg. 2013;2(3):280–7. https://doi.org/10.3978/j.issn.2225-319X.2013.05.09.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Liu J, Yang F, Chen L, et al. Management and otcomes of non-A non-B aortic dissection. Eur J Vasc Endovasc Surg: Off J Eur Soc Vasc Surg. 2022;64(5):497–506. https://doi.org/10.1016/j.ejvs.2022.05.037.

    Article  Google Scholar 

  23. Czerny M, Weigang E, Sodeck G, et al. Targeting landing zone 0 by total arch rerouting and TEVAR: midterm results of a transcontinental registry. Ann Thorac Surg. 2012;94(1):84–9. https://doi.org/10.1016/j.athoracsur.2012.03.024.

    Article  PubMed  Google Scholar 

  24. Roselli EE, Abdel-Halim M, Johnston DR, et al. Open aortic repair after prior thoracic endovascular aortic repair. Ann Thorac Surg. 2014;97(3):750–6. https://doi.org/10.1016/j.athoracsur.2013.10.033.

    Article  PubMed  Google Scholar 

  25. Sun L, Qi R, Zhu J, Liu Y, Zheng J. Total arch replacement combined with stented elephant trunk implantation: a new “standard” therapy for type a dissection involving repair of the aortic arch? Circulation. 2011;123(9):971–8. https://doi.org/10.1161/CIRCULATIONAHA.110.015081.

    Article  PubMed  Google Scholar 

  26. Chen Y, Zhang S, Liu L, Lu Q, Zhang T, Jing Z. Retrograde type A aortic dissection after thoracic endovascular aortic repair: a systematic review and meta-analysis. J Am Heart Assoc. 2017;6(9). https://doi.org/10.1161/JAHA.116.004649

  27. Zhang R, Zhou J, Feng J, et al. Inducing false lumen thrombosis for retrograde type A aortic dissection. J Thorac Cardiovasc Surg. 2017;153(1):57–65. https://doi.org/10.1016/j.jtcvs.2016.09.022.

    Article  PubMed  Google Scholar 

  28. Shu C, Wang T, Li Q-M, et al. Thoracic endovascular aortic repair for retrograde type A aortic dissection with an entry tear in the descending aorta. J Vasc Interv Radiol. 2012;23(4)https://doi.org/10.1016/j.jvir.2011.12.023

  29. Lu S, Lai H, Wang C, et al. Surgical treatment for retrograde type A aortic dissection after endovascular stent graft placement for type B dissection. Interact Cardiovasc Thorac Surg. 2012;14(5):538–42. https://doi.org/10.1093/icvts/ivs043.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Hu W, Zhang Y, Guo L, Fan J, Lu Y, Ma L. A graft inversion technique for retrograde type A aortic dissection after thoracic endovascular repair for type B aortic dissection. J Cardiothorac Surg. 2019;14(1):29. https://doi.org/10.1186/s13019-019-0851-9.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The authors thank AiMi Academic Services (http://www.aimieditor.com) for English language editing and review services.

Funding

This study was supported by the Beijing Advanced Innovation Center for Big Data-based Precision Medicine (No. PXM2021_014226_000026), National Natural Science Foundation of China (No. 82070483), Beijing Natural Science Foundation (No. 7232037 & L232030), Scientific Research Common Program of Beijing Municipal Commission of Education (No. KM202110025014), Beijing Hospitals Authority Clinical medicine Development of special funding support (No.XMLX202107 & ZLRL202317), Beijing Municipal Science & Technology Commission (No. Z221100007422015 & No. Z211100002921010).

Author information

Authors and Affiliations

  1. Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Street, Beijing, 100029, Chaoyang District, China

    Yuan Xue, Shipan Wang, Xiaomeng Wang, Hongjia Zhang & Haiyang Li

  2. Lung and Blood Vessel Diseases, Beijing Institute of Heart, Beijing, 100029, China

    Yuan Xue, Shipan Wang, Xiaomeng Wang, Hongjia Zhang & Haiyang Li

  3. Beijing Laboratory for Cardiovascular Precision Medicine, Beijing, 100029, China

    Yuan Xue, Shipan Wang, Xiaomeng Wang, Hongjia Zhang & Haiyang Li

  4. School of Life Science, Beijing Institute of Technology, Beijing, 100081, China

    Xuehuan Zhang & Duanduan Chen

  5. Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, 300072, China

    Yue Shi

  6. School of Medical Technology, Beijing Institute of Technology, No. 5 Zhongguancun South Street, Beijing, 100081, Haidian District, China

    Duanduan Chen

Authors
  1. Yuan Xue
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shipan Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Xuehuan Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Xiaomeng Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yue Shi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hongjia Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Duanduan Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Haiyang Li
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Yuan Xue and Shipan Wang conceived the idea and conceptualized the study. Xuehuan Zhang and Xiaomeng Wang collected the data. Hongjia Zhang and Duanduan Chen analyzed the data. Shipan Wang, Xiaomeng Wang, and Haiyang Li drafted the manuscript, then Yue Shi and Haiyang Li reviewed the manuscript. All authors read and approved the final draft.

Corresponding authors

Correspondence to Duanduan Chen or Haiyang Li.

Ethics declarations

Ethics Approval and Consent to Participate

The study protocol was approved by Anzhen Hospital (Institutional Review Board File 2014019) and was performed in accordance with the Declaration of Helsinki. Patients who agreed to sign informed consent were sequentially recruited.

Consent for Publication

Not applicable.

Competing Interests

The authors declare that they have no competing interests.

Additional information

Yuan Xue, Shipan Wang, and Xuehuan Zhang contributed equally to this study.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 84 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Xue, Y., Wang, S., Zhang, X. et al. Surgical Treatment for Type A Aortic Dissection after Endovascular Aortic Repair: A 12-year, Single-Center Study. Cardiovasc Drugs Ther (2024). https://doi.org/10.1007/s10557-024-07565-1

Download citation

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s10557-024-07565-1

Keywords

Search

Navigation