Eur J Cardiothorac Surg. 2023 Mar 24:ezad102. doi: 10.1093/ejcts/ezad102. Online ahead of print.
ABSTRACT
OBJECTIVES: The optimal treatment for acute type A aortic dissection (AAAD) with thrombosed false lumen (T-FL) of the ascending aorta remains controversial. This study aimed to the evaluate clinical outcomes of initial medical treatment (IMT) and the effectiveness of thoracic endovascular aortic repair (TEVAR) for AAAD with T-FL.
METHODS: We retrospectively analysed 60 AAAD with T-FL patients. Emergent aortic repair was performed in 33 patients and IMT was selected in 27 uncomplicated patients with ascending aortic diameter < 50 mm and ascending T-FL thickness ≤ 10 mm.
RESULTS: Among the 27 patients who received IMT, 14 had intramural haematoma at admission; however, new ulcer-like projections appeared in 7 (50%) during hospitalization. Before discharge, 12 (44%) were treated with only medical treatment and 15 (56%) required delayed aortic repair including TEVAR in 8 and open repair in 7. The median interval from onset to delayed repair was 9 days and significantly more patients received TEVAR compared to those receiving emergent repair (53% vs 21%; P = 0.043). Between TEVAR (n = 15) and open repair (n = 33), one (7%) 30-day mortality occurred in TEVAR, whereas no in-hospital mortality occurred in open repair. During the median follow-up time of 24.8 months, no aorta-related death was observed and there were no statistically significant differences in the freedom rate from aortic events (TEVAR: 92.8%/3 years vs open repair: 88.4%/3 years; P = 0.871).
CONCLUSIONS: Our management with a combination of emergent aortic repair, IMT, and delayed aortic repair for AAAD with T-FL achieved favourable clinical outcomes. In the selected Japanese patients, IMT with repeated MDCT could detect a new intimal tear which could be closed by TEVAR in some cases and TEVAR for this pathology resulted in acceptable early and mid-term outcomes. Further investigations are required to validate the safety and efficacy of this management.
PMID:36961338 | DOI:10.1093/ejcts/ezad102
