Ken Nakamura, Kimihiro Kobayashi, Shingo Nakai, Ri Sho, Shusuke Arai, Ai Ishizawa, Daisuke Watanabe, Shuto Hirooka, Eiichi Ohba, Masahiro Mizumoto, Yoshinori Kuroda, Cholsu Kim, Hideaki Uchino, Takao Shimanuki, Tetsuro Uchida
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This study aimed to determine the short- and long-term outcomes of preemptive TEVAR for uncomplicated TBAD with a small aortic aneurysm.</p><p><strong>Design: </strong>Retrospective multicenter analysis.</p><p><strong>Methods: </strong>We analyzed 212 patients with medically treated uncomplicated subacute TBAD between July 2004 and October 2019 in two Japanese academic centers. The short- and long-term prognosis of patients who underwent preemptive TEVAR and the changes in aortic diameter over time after TEVAR were analyzed. Aorta-related complications, aortic-related death and postoperative complications were recorded and analyzed. Analysis was performed on an intension-to-treat basis.</p><p><strong>Results: </strong>During follow-up, patients were divided into two groups: optimal medical treatment [OMT; <i>n</i> = 185 (87%)] and preemptive TEVAR [<i>n</i> = 27 (13%)]. In all cases, aortic enlargement was the reason for therapeutic intervention in the preemptive TEVAR group. Propensity score matching yielded a cohort of 27 control patients with OMT (group A) and 27 patients who underwent preemptive TEVAR (group B). Preoperative characteristics were similar between groups. In group B, only one patient developed type A dissection at a late stage and died from aortic rupture. Freedom from aortic-related death at 1/5/10 years was 100%/92%/92% in group B. Overall growth (mm/year) of max aorta was significantly smaller in the TEVAR group than in the control group (-3.7 ± 2.9 vs. 0.4 ± 5.6, <i>p</i> < 0.01), and the diameter of the false lumen was reduced (-8 ± 4.8 vs. -1.3 ± 8.0, <i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>Short- and long-term outcomes of TEVAR for uncomplicated TBAD with a small aortic aneurysm were excellent, with few postoperative complications. 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引用次数: 0
摘要
目的：先发制人的胸腔内血管主动脉修复术（TEVAR）有可能改善斯坦福B型主动脉夹层（TBAD）的预后，但重要的是确定其是否能作为预防性治疗安全实施。本研究旨在确定对伴有小主动脉瘤的无并发症TBAD进行先期TEVAR治疗的短期和长期疗效：设计：回顾性多中心分析：我们分析了2004年7月至2019年10月期间在日本两个学术中心接受药物治疗的212名无并发症亚急性TBAD患者。分析了先行 TEVAR 患者的短期和长期预后，以及 TEVAR 后主动脉直径随时间的变化。记录并分析了主动脉相关并发症、主动脉相关死亡和术后并发症。分析以意向治疗为基础：随访期间，患者被分为两组：最佳药物治疗[OMT；n = 185（87%）]和先期TEVAR[n = 27（13%）]。在所有病例中，主动脉扩大是先发制人 TEVAR 组进行治疗干预的原因。倾向得分匹配得出的队列包括 27 名接受 OMT 的对照组患者（A 组）和 27 名接受先发制人 TEVAR 的患者（B 组）。两组患者的术前特征相似。在 B 组中，只有一名患者在晚期出现 A 型夹层，死于主动脉破裂。TEVAR组的最大主动脉总体增长（毫米/年）明显小于对照组（-3.7 ± 2.9 vs. 0.4 ± 5.6，p p 结论：TEVAR治疗无并发症的TBAD和小主动脉瘤的短期和长期疗效都很好，术后并发症很少。TEVAR 术后短期内可观察到主动脉重塑，这表明 TEVAR 有助于预防主动脉破裂导致的死亡。
Safe and favorable prognosis of thoracic endovascular aortic repair for the low-risk patients with non-acute type B aortic dissection.
Objective: Preemptive thoracic endovascular aortic repair (TEVAR) has the potential to improve the prognosis of Stanford type B aortic dissection (TBAD), however it is important to determine whether it could be safely performed as a prophylactic treatment. This study aimed to determine the short- and long-term outcomes of preemptive TEVAR for uncomplicated TBAD with a small aortic aneurysm.
Design: Retrospective multicenter analysis.
Methods: We analyzed 212 patients with medically treated uncomplicated subacute TBAD between July 2004 and October 2019 in two Japanese academic centers. The short- and long-term prognosis of patients who underwent preemptive TEVAR and the changes in aortic diameter over time after TEVAR were analyzed. Aorta-related complications, aortic-related death and postoperative complications were recorded and analyzed. Analysis was performed on an intension-to-treat basis.
Results: During follow-up, patients were divided into two groups: optimal medical treatment [OMT; n = 185 (87%)] and preemptive TEVAR [n = 27 (13%)]. In all cases, aortic enlargement was the reason for therapeutic intervention in the preemptive TEVAR group. Propensity score matching yielded a cohort of 27 control patients with OMT (group A) and 27 patients who underwent preemptive TEVAR (group B). Preoperative characteristics were similar between groups. In group B, only one patient developed type A dissection at a late stage and died from aortic rupture. Freedom from aortic-related death at 1/5/10 years was 100%/92%/92% in group B. Overall growth (mm/year) of max aorta was significantly smaller in the TEVAR group than in the control group (-3.7 ± 2.9 vs. 0.4 ± 5.6, p < 0.01), and the diameter of the false lumen was reduced (-8 ± 4.8 vs. -1.3 ± 8.0, p < 0.001).
Conclusions: Short- and long-term outcomes of TEVAR for uncomplicated TBAD with a small aortic aneurysm were excellent, with few postoperative complications. After TEVAR, aortic remodeling was observed in the short term, suggesting that it may contribute to the prevention of aortic-related death due to rupture.
期刊介绍：
Frontiers? Which frontiers? Where exactly are the frontiers of cardiovascular medicine? And who should be defining these frontiers?
At Frontiers in Cardiovascular Medicine we believe it is worth being curious to foresee and explore beyond the current frontiers. In other words, we would like, through the articles published by our community journal Frontiers in Cardiovascular Medicine, to anticipate the future of cardiovascular medicine, and thus better prevent cardiovascular disorders and improve therapeutic options and outcomes of our patients.
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