Bavaria Joseph E, Brinkman William T, Hughes G Chad, Shah Aamir S, Charlton-Ouw Kristofer M, Azizzadeh Ali, White Rodney A
Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa.
Department of Surgery, The Heart Hospital Baylor Plano, Plano, Tex.
J Thorac Cardiovasc Surg. 2022 Feb;163(2):539-548.e2. doi: 10.1016/j.jtcvs.2020.03.162. Epub 2020 May 13.
Thoracic endovascular aortic repair is the standard of care for acute complicated type B aortic dissections, but long-term single-device outcomes are limited.
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.
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.
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.
胸主动脉腔内修复术是急性复杂性B型主动脉夹层的标准治疗方法，但单一器械的长期疗效有限。
在这项前瞻性、非随机的夹层试验中，50例急性复杂性B型主动脉夹层患者接受了Valiant Captivia胸主动脉覆膜支架移植物（美敦力公司，加利福尼亚州圣罗莎）治疗。评估全因死亡率、二次手术和严重不良事件，一个核心实验室评估主动脉重塑的影像。
5年时，可获得随访的患者临床和影像随访的依从率为78%（23例中的18例）。显著的基线特征为86%的患者（50例中的43例）存在灌注不良，20%（50例中的10例）有破裂，94%（49例中的46例）为DeBakey IIIB型夹层。5年时与夹层相关的死亡率、与夹层相关的二次手术和内漏的无事件生存率分别为83%、86%和85%。5年后，89%的患者（18例中的16例）主动脉支架置入段的假腔完全血栓形成，94%的患者（17例中的16例）支架移植物长度范围内真腔直径稳定或增加，而5年后77%（17例中的13例）患者假腔直径稳定或减小。
在夹层试验中，患者经历了积极且持续的主动脉重塑指标。生存结果、二次手术需求和不良事件发生率与既往胸主动脉腔内修复术研究一致。尽管随访依从性存在局限性，但Valiant Captivia胸主动脉覆膜支架移植物系统对于这一具有挑战性病情的患者群体中急性复杂性B型主动脉夹层的长期管理是有效的。
