Questionable Long-Term Results of the Extended Provisional Extension to Induce Complete Attachment (E-PETTICOAT) Technique in the Management of Chronic Type B Aortic Dissection

Abstract

Published interim results of the extended provisional extension to induce complete attachment (e-PETTICOAT) technique suggested favorable remodeling in chronic type B Aortic Dissection (cTBAD). This report presents long-term results of the e-PETTICOAT technique for the management of cTBAD (without aneurysmal dilatation). Patients with cTBAD below the 55mm aortic size were eligible for the management using the e-PETTICOAT technique. Follow-up was conducted at 1, 2 and 5years based on the computed tomography angiogram. All the presurgery risk factors (entry >1cm, inner curve entry, fusiform index >0.65, false lumen>22mm, aortic size >40mm, recurrent pain or hypertension, and Stanford Dissection Risk Calculation) and postsurgery complications were examined in the study. A total of 20 patients underwent the e-PETTICOAT surgery. The survival rate at 1, 2, and 5years was 75%, 70%, and 64%, respectively, and the percentage of patients without any reinterventions was 100%, 93%, and 18%. Aortic degeneration was recognized in 30%, 55%, and 85% of the patients. Only 3 of the 20 patients were alive and without any reintervention after 5years. The receiver operating curve analysis does not indicate any factor that would predict the remodeling result in the long-term follow-up. The use of e-PETTICOAT technique in cTBAD might not have a beneficial influence on the long-term results.