Early and midterm results of thoracic endovascular aortic repair of chronic type B aortic dissection

Objective: The optimal treatment for chronic type B dissection remains controversial. This study reports early and midterm results of thoracic endovascular aortic repair for chronic type B aortic dissection. Methods: From June 2001 to September 2007, a total of 84 patients with chronic type B aortic dissection underwent thoracic endovascular aortic repair. The time between onset of dissection and thoracic endovascular aortic repair was 13.9 +/- 22.0 months (range, 1-120 months). All patients were followed up from 6 to 86 months (mean, 33.2 +/- 19.2 months). Results: The entry tear was completely sealed in 77 cases (91.7%) during thoracic endovascular aortic repair. The incidence of incomplete seal was 8.3%. The 1-month mortality was 1.2%. One patient had retrograde type A dissection 1 month after the operation. Four patients underwent a second thoracic endovascular aortic repair during follow-up, for endoleak in 3 patients and for newly formed intimal tear in 1 patient. Seven patients (8.3%) died during follow-up. Three died of rupture of the thoracic aorta because of endoleak. The Kaplan-Meier actuarial survival curve showed a 5-year survival of 84.4%. At 5 years, 75.2% of patients were alive with neither endoleak nor reintervention. Conclusions: Early and midterm results show that thoracic endovascular aortic repair was effective in the treatment of chronic type B aortic dissection. Endoleak was the main cause of death during follow-up. With increased surgical experience and refinement of the stent graft, results are likely to improve in the future. (J Thorac Cardiovasc Surg 2010;139:1548-53)