RF19 ENDOVASCULAR SURGERY FOR TYBE B AORTIC DISSECTION: IS THERE A DIFFERENCE BETWEEN ACUTE AND CHRONIC?

Abstract

Background and aim: Open surgery for type B Aortic Dissection remains a clinical challenge with high morbidity and mortality. Thoracic EndoVascular Aortic Repair (TEVAR) is developing as a strong alternative to open surgery for treatment of acute and chronic type B Aortic Dissection. TEVAR has shown improved early and late results, compared with open surgery or medical therapy, mostly in complicated patients. To assess if there are some differences in clinical outcome after TEVAR for acute or chronic TAAD, we reviewed our long term experience. Methods: From March 2001 to March 2018, out of 289 patients underwent TEVAR, 141 were treated for TAAD (48.8%), 88 for acute (within 14 days) and 53 for chronic dissection (after 14 days). The procedures were performed in a hybrid operating room. Patients received general anesthesia and mechanical ventilation with invasive monitoring. The delivery system was inserted through femoral or iliac artery. Results: The overall 30-days mortality was 3.5% (5 patients), All deaths were the result of preoperative malperfusion. There were no neurological complications or paraplegia. At long-term follow-up, aortic related mortality was 7.8% (11 patients) A secondary endovascular or conventional procedure was required in 26 patients (18.4%). There were no statistically significant differences between groups. Conclusions: Early and late outcome supports the safety and effectiveness of TEVAR for type B aortic dissection without differences between acute and chronic group. Mortality and morbidity is predominantly related to the patient preoperative status. However, long-term follow-up is mandatory to confirm clinical safety of this procedure