Transaortic and transfemoral stent deployment approaches related morphological and clinical outcomes after type II hybrid arch repair for type A aortic dissection.

Abstract

We aimed to evaluate the false lumen patency and late death outcomes of type II hybrid arch repair for type A aortic dissection (TAAD) using the transaortic (TA) and transfemoral (TF) stent deployment approaches. Patients who underwent type II hybrid arch repair for TAAD between September 2013 and November 2020 were enrolled. False lumen patency (classified as patent false lumen, thrombosed false lumen, or false lumen remodeling) and follow-up death were investigated. Multivariate Cox regression and inverse probability of treatment weighting (IPTW) analyses were used to evaluate the association between the outcomes and stent graft deployment approaches. Of the 129 enrolled patients, 23 (17.8%) and 106 (82.2%) were in the TA and TF groups, respectively. During follow-up (median: 42 months, IQR: 32-82 months), higher risks of patent false lumen (odds ratio [OR]: 4.0, 95% confidence interval [CI]: 1.01-16.6, P = 0.03) and all-cause death (hazards ratio [HR]: 5.8, 95% CI: 1.3-25.8, P = 0.02) were observed in TA group than in TF group. In IPTW analysis, TA group showed consistently higher adjusted risks of patent false lumen (adjusted OR: 4.1, 95% CI: 1.6-10.3, P = 0.003) and all-cause death (adjusted HR: 4.5, 95% CI: 1.1-18.7, P = 0.03) than that of TF group. This study demonstrated the TA and TF deployment approaches related to false lumen patency and survival outcomes after type II hybrid arch repair for TAAD. The TA approach was associated with higher risks of patent false lumen and late death during follow-up. The TF approach should be suggested as the primary choice for stent deployment in type II hybrid arch repair for TAAD.