Endovascular Repair of Type B Aortic Dissection: Long-term Results of the Randomized Investigation of Stent Grafts in Aortic Dissection Trial

BACKGROUND—Thoracic endovascular aortic repair (TEVAR) represents a therapeutic concept for type B aortic dissection. Long-term outcomes and morphology after TEVAR for uncomplicated dissection are unknown. METHODS AND RESULTS—A total of 140 patients with stable type B aortic dissection previously ra...

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Published in	Circulation. Cardiovascular interventions Vol. 6; no. 4; pp. 407 - 416
Main Authors	Nienaber, Christoph A., Kische, Stephan, Rousseau, Hervé, Eggebrecht, Holger, Rehders, Tim C., Kundt, Guenther, Glass, Aenne, Scheinert, Dierk, Czerny, Martin, Kleinfeldt, Tilo, Zipfel, Burkhart, Labrousse, Louis, Fattori, Rossella, Ince, Hüseyin
Format	Journal Article
Language	English
Published	United States American Heart Association, Inc 01.08.2013
Subjects	Adult Aged Aneurysm, Dissecting - mortality Aneurysm, Dissecting - pathology Aneurysm, Dissecting - surgery Aorta, Thoracic - pathology Aortic Aneurysm, Thoracic - mortality Aortic Aneurysm, Thoracic - pathology Aortic Aneurysm, Thoracic - surgery Blood Vessel Prosthesis Implantation - methods Disease Progression Female Humans Male Middle Aged Proportional Hazards Models Stents aortic remodeling aortic dissection prognosis stent graft
Online Access	Get full text
ISSN	1941-7640 1941-7632 1941-7632
DOI	10.1161/CIRCINTERVENTIONS.113.000463

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Abstract	BACKGROUND—Thoracic endovascular aortic repair (TEVAR) represents a therapeutic concept for type B aortic dissection. Long-term outcomes and morphology after TEVAR for uncomplicated dissection are unknown. METHODS AND RESULTS—A total of 140 patients with stable type B aortic dissection previously randomized to optimal medical treatment and TEVAR (n=72) versus optimal medical treatment alone (n=68) were analyzed retrospectively for aorta-specific, all-cause outcomes, and disease progression using landmark statistical analysis of years 2 to 5 after index procedure. Cox regression was used to compare outcomes between groups; all analyses are based on intention to treat. The risk of all-cause mortality (11.1% versus 19.3%; P=0.13), aorta-specific mortality (6.9% versus 19.3%; P=0.04), and progression (27.0% versus 46.1%; P=0.04) after 5 years was lower with TEVAR than with optimal medical treatment alone. Landmark analysis suggested a benefit of TEVAR for all end points between 2 and 5 years; for example, for all-cause mortality (0% versus 16.9%; P=0.0003), aorta-specific mortality (0% versus 16.9%; P=0.0005), and for progression (4.1% versus 28.1%; P=0.004); Landmarking at 1 year and 1 month revealed consistent findings. Both improved survival and less progression of disease at 5 years after elective TEVAR were associated with stent graft induced false lumen thrombosis in 90.6% of cases (P<0.0001). CONCLUSIONS—In this study of survivors of type B aortic dissection, TEVAR in addition to optimal medical treatment is associated with improved 5-year aorta-specific survival and delayed disease progression. In stable type B dissection with suitable anatomy, preemptive TEVAR should be considered to improve late outcome. CLINICAL TRIAL REGISTRATION—URLhttp://www.clinicaltrials.gov. Unique identifierNCT01415804.
AbstractList	Thoracic endovascular aortic repair (TEVAR) represents a therapeutic concept for type B aortic dissection. Long-term outcomes and morphology after TEVAR for uncomplicated dissection are unknown.BACKGROUNDThoracic endovascular aortic repair (TEVAR) represents a therapeutic concept for type B aortic dissection. Long-term outcomes and morphology after TEVAR for uncomplicated dissection are unknown.A total of 140 patients with stable type B aortic dissection previously randomized to optimal medical treatment and TEVAR (n=72) versus optimal medical treatment alone (n=68) were analyzed retrospectively for aorta-specific, all-cause outcomes, and disease progression using landmark statistical analysis of years 2 to 5 after index procedure. Cox regression was used to compare outcomes between groups; all analyses are based on intention to treat. The risk of all-cause mortality (11.1% versus 19.3%; P=0.13), aorta-specific mortality (6.9% versus 19.3%; P=0.04), and progression (27.0% versus 46.1%; P=0.04) after 5 years was lower with TEVAR than with optimal medical treatment alone. Landmark analysis suggested a benefit of TEVAR for all end points between 2 and 5 years; for example, for all-cause mortality (0% versus 16.9%; P=0.0003), aorta-specific mortality (0% versus 16.9%; P=0.0005), and for progression (4.1% versus 28.1%; P=0.004); Landmarking at 1 year and 1 month revealed consistent findings. Both improved survival and less progression of disease at 5 years after elective TEVAR were associated with stent graft induced false lumen thrombosis in 90.6% of cases (P<0.0001).METHODS AND RESULTSA total of 140 patients with stable type B aortic dissection previously randomized to optimal medical treatment and TEVAR (n=72) versus optimal medical treatment alone (n=68) were analyzed retrospectively for aorta-specific, all-cause outcomes, and disease progression using landmark statistical analysis of years 2 to 5 after index procedure. Cox regression was used to compare outcomes between groups; all analyses are based on intention to treat. The risk of all-cause mortality (11.1% versus 19.3%; P=0.13), aorta-specific mortality (6.9% versus 19.3%; P=0.04), and progression (27.0% versus 46.1%; P=0.04) after 5 years was lower with TEVAR than with optimal medical treatment alone. Landmark analysis suggested a benefit of TEVAR for all end points between 2 and 5 years; for example, for all-cause mortality (0% versus 16.9%; P=0.0003), aorta-specific mortality (0% versus 16.9%; P=0.0005), and for progression (4.1% versus 28.1%; P=0.004); Landmarking at 1 year and 1 month revealed consistent findings. Both improved survival and less progression of disease at 5 years after elective TEVAR were associated with stent graft induced false lumen thrombosis in 90.6% of cases (P<0.0001).In this study of survivors of type B aortic dissection, TEVAR in addition to optimal medical treatment is associated with improved 5-year aorta-specific survival and delayed disease progression. In stable type B dissection with suitable anatomy, preemptive TEVAR should be considered to improve late outcome.CONCLUSIONSIn this study of survivors of type B aortic dissection, TEVAR in addition to optimal medical treatment is associated with improved 5-year aorta-specific survival and delayed disease progression. In stable type B dissection with suitable anatomy, preemptive TEVAR should be considered to improve late outcome.http://www.clinicaltrials.gov. Unique identifier: NCT01415804.CLINICAL TRIAL REGISTRATION URLhttp://www.clinicaltrials.gov. Unique identifier: NCT01415804. BACKGROUND—Thoracic endovascular aortic repair (TEVAR) represents a therapeutic concept for type B aortic dissection. Long-term outcomes and morphology after TEVAR for uncomplicated dissection are unknown. METHODS AND RESULTS—A total of 140 patients with stable type B aortic dissection previously randomized to optimal medical treatment and TEVAR (n=72) versus optimal medical treatment alone (n=68) were analyzed retrospectively for aorta-specific, all-cause outcomes, and disease progression using landmark statistical analysis of years 2 to 5 after index procedure. Cox regression was used to compare outcomes between groups; all analyses are based on intention to treat. The risk of all-cause mortality (11.1% versus 19.3%; P=0.13), aorta-specific mortality (6.9% versus 19.3%; P=0.04), and progression (27.0% versus 46.1%; P=0.04) after 5 years was lower with TEVAR than with optimal medical treatment alone. Landmark analysis suggested a benefit of TEVAR for all end points between 2 and 5 years; for example, for all-cause mortality (0% versus 16.9%; P=0.0003), aorta-specific mortality (0% versus 16.9%; P=0.0005), and for progression (4.1% versus 28.1%; P=0.004); Landmarking at 1 year and 1 month revealed consistent findings. Both improved survival and less progression of disease at 5 years after elective TEVAR were associated with stent graft induced false lumen thrombosis in 90.6% of cases (P<0.0001). CONCLUSIONS—In this study of survivors of type B aortic dissection, TEVAR in addition to optimal medical treatment is associated with improved 5-year aorta-specific survival and delayed disease progression. In stable type B dissection with suitable anatomy, preemptive TEVAR should be considered to improve late outcome. CLINICAL TRIAL REGISTRATION—URLhttp://www.clinicaltrials.gov. Unique identifierNCT01415804. Thoracic endovascular aortic repair (TEVAR) represents a therapeutic concept for type B aortic dissection. Long-term outcomes and morphology after TEVAR for uncomplicated dissection are unknown. A total of 140 patients with stable type B aortic dissection previously randomized to optimal medical treatment and TEVAR (n=72) versus optimal medical treatment alone (n=68) were analyzed retrospectively for aorta-specific, all-cause outcomes, and disease progression using landmark statistical analysis of years 2 to 5 after index procedure. Cox regression was used to compare outcomes between groups; all analyses are based on intention to treat. The risk of all-cause mortality (11.1% versus 19.3%; P=0.13), aorta-specific mortality (6.9% versus 19.3%; P=0.04), and progression (27.0% versus 46.1%; P=0.04) after 5 years was lower with TEVAR than with optimal medical treatment alone. Landmark analysis suggested a benefit of TEVAR for all end points between 2 and 5 years; for example, for all-cause mortality (0% versus 16.9%; P=0.0003), aorta-specific mortality (0% versus 16.9%; P=0.0005), and for progression (4.1% versus 28.1%; P=0.004); Landmarking at 1 year and 1 month revealed consistent findings. Both improved survival and less progression of disease at 5 years after elective TEVAR were associated with stent graft induced false lumen thrombosis in 90.6% of cases (P<0.0001). In this study of survivors of type B aortic dissection, TEVAR in addition to optimal medical treatment is associated with improved 5-year aorta-specific survival and delayed disease progression. In stable type B dissection with suitable anatomy, preemptive TEVAR should be considered to improve late outcome. http://www.clinicaltrials.gov. Unique identifier: NCT01415804.
Author	Czerny, Martin Kleinfeldt, Tilo Zipfel, Burkhart Fattori, Rossella Nienaber, Christoph A. Labrousse, Louis Eggebrecht, Holger Kundt, Guenther Rousseau, Hervé Ince, Hüseyin Glass, Aenne Scheinert, Dierk Kische, Stephan Rehders, Tim C.
AuthorAffiliation	From the University of Rostock, Heart Center and Institute for Biostatistics, Rostock, Germany (C.A.N., S.K., T.C.R., G.K., A.G., T.K., H.I.); CCB Heart Center Frankfurt, Frankfurt, Germany (H.E.); University Heart Center Leipzig, Leipzig, Germany (D.S.); German Heart Institute Berlin, Berlin, Germany (B.Z.); the Centre Hospitalière Universitaire, Hôpital de Rangueil, Toulouse, France (H.R.); the Universitá St. Orsola Malpighi, Bologna, Italy (R.F.); the Department of Cardiovascular Surgery, University Hospital Berne, Berne, Switzerland (M.C.); and Bordeaux Heart University Hospital, Bordeaux, France (L.L.)
AuthorAffiliation_xml	– name: From the University of Rostock, Heart Center and Institute for Biostatistics, Rostock, Germany (C.A.N., S.K., T.C.R., G.K., A.G., T.K., H.I.); CCB Heart Center Frankfurt, Frankfurt, Germany (H.E.); University Heart Center Leipzig, Leipzig, Germany (D.S.); German Heart Institute Berlin, Berlin, Germany (B.Z.); the Centre Hospitalière Universitaire, Hôpital de Rangueil, Toulouse, France (H.R.); the Universitá St. Orsola Malpighi, Bologna, Italy (R.F.); the Department of Cardiovascular Surgery, University Hospital Berne, Berne, Switzerland (M.C.); and Bordeaux Heart University Hospital, Bordeaux, France (L.L.)
Author_xml	– sequence: 1 givenname: Christoph surname: Nienaber middlename: A. fullname: Nienaber, Christoph A. organization: From the University of Rostock, Heart Center and Institute for Biostatistics, Rostock, Germany (C.A.N., S.K., T.C.R., G.K., A.G., T.K., H.I.); CCB Heart Center Frankfurt, Frankfurt, Germany (H.E.); University Heart Center Leipzig, Leipzig, Germany (D.S.); German Heart Institute Berlin, Berlin, Germany (B.Z.); the Centre Hospitalière Universitaire, Hôpital de Rangueil, Toulouse, France (H.R.); the Universitá St. Orsola Malpighi, Bologna, Italy (R.F.); the Department of Cardiovascular Surgery, University Hospital Berne, Berne, Switzerland (M.C.); and Bordeaux Heart University Hospital, Bordeaux, France (L.L.) – sequence: 2 givenname: Stephan surname: Kische fullname: Kische, Stephan – sequence: 3 givenname: Hervé surname: Rousseau fullname: Rousseau, Hervé – sequence: 4 givenname: Holger surname: Eggebrecht fullname: Eggebrecht, Holger – sequence: 5 givenname: Tim surname: Rehders middlename: C. fullname: Rehders, Tim C. – sequence: 6 givenname: Guenther surname: Kundt fullname: Kundt, Guenther – sequence: 7 givenname: Aenne surname: Glass fullname: Glass, Aenne – sequence: 8 givenname: Dierk surname: Scheinert fullname: Scheinert, Dierk – sequence: 9 givenname: Martin surname: Czerny fullname: Czerny, Martin – sequence: 10 givenname: Tilo surname: Kleinfeldt fullname: Kleinfeldt, Tilo – sequence: 11 givenname: Burkhart surname: Zipfel fullname: Zipfel, Burkhart – sequence: 12 givenname: Louis surname: Labrousse fullname: Labrousse, Louis – sequence: 13 givenname: Rossella surname: Fattori fullname: Fattori, Rossella – sequence: 14 givenname: Hüseyin surname: Ince fullname: Ince, Hüseyin
BackLink	https://www.ncbi.nlm.nih.gov/pubmed/23922146$$D View this record in MEDLINE/PubMed
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Copyright	2013 American Heart Association, Inc.
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Snippet	BACKGROUND—Thoracic endovascular aortic repair (TEVAR) represents a therapeutic concept for type B aortic dissection. Long-term outcomes and morphology after... Thoracic endovascular aortic repair (TEVAR) represents a therapeutic concept for type B aortic dissection. Long-term outcomes and morphology after TEVAR for...
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SubjectTerms	Adult Aged Aneurysm, Dissecting - mortality Aneurysm, Dissecting - pathology Aneurysm, Dissecting - surgery Aorta, Thoracic - pathology Aortic Aneurysm, Thoracic - mortality Aortic Aneurysm, Thoracic - pathology Aortic Aneurysm, Thoracic - surgery Blood Vessel Prosthesis Implantation - methods Disease Progression Female Humans Male Middle Aged Proportional Hazards Models Stents
Title	Endovascular Repair of Type B Aortic Dissection: Long-term Results of the Randomized Investigation of Stent Grafts in Aortic Dissection Trial
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