Open Repair Of Acute Type Research Articles

Distal aortic progression following acute type A aortic dissection repair among patients with bicuspid and tricuspid aortic valves

ObjectiveThe study objective was to analyze long-term growth and outcomes of the distal aorta after open acute type A aortic dissection repair in patients with bicuspid aortic valves or tricuspid aortic valves without connective tissue disease. MethodsFrom 1996 to 2021, 60 patients with bicuspid aortic valves and 655 patients with tricuspid aortic valves without connective tissue disease underwent open repair for acute type A aortic dissection. Data were collected from the local Society of Thoracic Surgeons database, medical record review, surveys, and the National Death Index and Michigan Death Index (December 12, 2021). ResultsCompared with the tricuspid aortic valve group, the bicuspid aortic valve group was significantly younger, had more severe aortic insufficiency (33% vs 22%, P = .05), and had less hypertension (67% vs 78%, P = .05). Intraoperatively, patients with bicuspid aortic valves received more aortic root replacements (70% vs 26%, P < .001), less zone 2 aortic arch replacement (8.3% vs 20%, P = .03), and longer median cardiopulmonary bypass (233 vs 214 minutes, P = .05) and aortic crossclamp (184 vs 141 minutes, P < .001) times. The average annual aortic arch growth rate (0.23 mm/year vs 0.39 mm/year, P = .52) and descending aorta growth rate (0.61 mm/year vs 0.79 mm/year, P = .39) were similar between the bicuspid aortic valve and tricuspid aortic valve groups. The bicuspid aortic valve group had lower annual abdominal aorta growth (0.51 mm/year vs 0.68 mm/year, P = .03). The cumulative incidence of reoperation for the distal aorta (9.7% vs 16.0%, P = .77) was similar between the bicuspid aortic valve and tricuspid aortic valve groups. The 10-year survival was higher in the bicuspid aortic valve group (75.4% vs 66.0%, P = .03). ConclusionsPatients with bicuspid aortic valves could be treated similarly as patients with tricuspid aortic valves without connective tissue disease in the setting of open acute type A aortic dissection repair.

The impact of prior cardiac surgery on patients undergoing surgical repair for acute type A aortic dissection.

To determine the impact of reoperative versus first-time sternotomy for emergent open repair of acute Type A aortic dissection (ATAAD). This was an observational study of consecutive aortic surgeries from 2007 to 2021. Kaplan-Meier survival estimation and multivariable Cox regression analysis were performed to assess the impact of reoperative versus first-time sternotomy upon survival after ATAAD repair. A total of 601 patients with ATAAD were identified, of which 72 (12%) underwent reoperative sternotomy. The reoperative group had a higher prevalence of baseline comorbidities, including hypertension, diabetes, peripheral vascular disease, atrial fibrillation, and coronary artery disease. Central cannulation of the aorta was achieved at a similar rate across each group (81.9% vs. 81.5%, p = .923), and cardiopulmonary bypass (CPB) time was similar across each group (204 ± 84.8 vs. 203 ± 72.4 min, p = .923). Postoperative outcomes were similar across both groups, including in-hospital mortality, stroke, pulmonary complications, renal failure, and reexploration for excessive bleeding. Five-year survival was 74.5% (70.5, 78.3) for the first-time group and was 71.6% (60.0, 81.9) for the reoperative group. After multivariable Cox regression, reoperative sternotomy was not significantly associated with an increased hazard of death compared to first-time sternotomy (hazards ratio: 0.90, 95% confidence interval: 0.56, 1.43, p = .642). These findings suggest that re-sternotomy can be safely performed with similar outcomes as first-time sternotomy. Central initiation of CPB after sternal reentry limits CPB time and may therefore represent a protective strategy that enhances outcomes for patients presenting with ATAAD and prior cardiac surgery.

Role of False Lumen Area Ratio in Late Aortic Events After Acute Type I Aortic Dissection Repair

BackgroundThe aim of this study was to investigate whether distal aortic maximum false lumen area (MFLA) ratio predicts late aortic dilation and reintervention after open repair of acute type I aortic dissection. MethodsWe analyzed 309 nonsyndromic acute type I aortic dissection patients who were treated with a repair to the proximal aorta between 1994 and 2017. In 230 patients who did not show completely thrombosed false lumen on postoperative computed tomography, the MFLA ratio (MFLA/aortic area) on the descending thoracic aorta (DTA) was measured with postoperative computed tomography. Patients were divided into 3 groups according to the quartile range of MFLA ratio: low MFLA, <0.62 (n = 57); intermediate MFLA, 0.62 to 0.81 (n = 116); and high MFLA, ≥0.82 (n = 57). ResultsThe aortic expansion rate was significantly higher in the high MFLA group (11.1 ± 21.2 mm/y) compared with intermediate (3.0 ± 7.4 mm/y; P < .01) and low (0.6 ± 6.6 mm/y; P < .01) MFLA groups. High MFLA was found to be an independent risk factor for significant aortic expansion (adjusted hazard ratio, 5.26; 95% CI, 1.53-18.12; P < .01) and aorta-related reintervention (hazard ratio, 4.99; 95% CI, 2.23-11.13; P < .01), and the MFLA ratio was significantly related to proximal DTA reentry tears (adjusted odds ratio, 12974.3; P < .001; area under curve, 0.807). ConclusionsA high MFLA ratio on the DTA after acute type I aortic dissection repair is associated with increased risk of late aortic reintervention and distal aortic dilation. A high MFLA ratio is strongly associated with proximal DTA reentry tears.

Cardiorespiratory Fitness After Open Repair for Acute Type A Aortic Dissection – A Prospective Study

Cardiorespiratory fitness (as measured by peak oxygen consumption [VO2peak]) is an independent predictor of cardiovascular disease and all-cause mortality. Limited data exist on VO2peak following repair for an acute type A aortic dissection (ATAAD) or proximal thoracic aortic aneurysm (pTAA). This study prospectively evaluated VO2peak, functional capacity, and health-related quality of life (HR-QOL) following open repair. Participants with a history of an ATAAD (n=21) or pTAA (n=43) performed cardiopulmonary exercise testing (CPX), 6-minute walk testing, and HR-QOL at 3 (early) and 15 (late) months following open repair. The median age at time of surgery was 55-years-old and 60-years-old in the ATAAD and pTAA groups, respectively. Body mass index significantly increased between early and late timepoints for both ATAAD (p=0.0245, 56% obese) and pTAA groups (p = 0.0045, 54% obese). VO2peak modestly increased by 0.8 mLO2·kg-1·min-1 within the ATAAD group (p=0.2312) while VO2peak significantly increased by 2.2 mLO2·kg-1·min-1 within the pTAA group (p=0.0003). Anxiety significantly decreased in the ATAAD group whereas functional capacity and HR-QOL metrics (social roles and activities, physical function) significantly improved in the pTAA group (p values < 0.05). There were no serious adverse events during CPX. Cardiorespiratory fitness among the ATAAD group remained 36% below predicted normative values >1 year after repair. CPX should be considered post-operatively to evaluate exercise tolerance and blood pressure response to determine whether mild-to-moderate aerobic exercise should be recommended to reduce future risk of morbidity and mortality.

The Impact of a Reentry Tear After Open Repair of Nonsyndromic Acute Type I Aortic Dissection

The role of a reentry tear in the descending thoracic aorta (DTA) after repair of acute aortic dissection is not well known. We therefore investigated the impact of reentry tear location on late aorta reintervention and the aortic expansion rate after open repair of acute type I aortic dissection. We analyzed 309 nonsyndromic acute type I aortic dissection patients who were treated with a repair to the proximal aorta between 1994 and 2017. The locations of reentry tears, identified with predischarge computed tomography, were the proximal DTA in 119 patients (38.5%), distal DTA in 78 (25.2%), and abdominal aorta in 129 (41.7%). Patients who had a proximal DTA reentry tear were defined as the PDR group (119 [38.5%]), and the others were defined as the non-PDR group (190 [61.5%]). The 15-year freedom from aorta reintervention was significantly lower in the PDR group (51.5% ± 0.7% vs 90.4% ± 4.4%, P < .001). The aortic expansion rates of the proximal DTA (7.6 ± 16.1 mm/y vs 0.1 ± 2.5 mm/y, P < .001) and distal DTA (6.8 ± 15.5 mm/y vs 0.3 ± 3.1 mm/y, P < .001) were significantly higher in the PDR group. The 15-year freedom from significant aortic expansion was significantly lower in the PDR group (34.6% ± 6.9% vs 83.6% ± 7.9%, P < .001). Multivariate analysis showed that a proximal DTA reentry tear was an independent risk factor for aorta reintervention (hazard ratio, 4.955; 95% confidence interval, 1.691-14.523; P= .004) and significant aortic expansion (HR, 4.214; 95% CI, 1.691-10.498; P= .002). A proximally located DTA reentry tear was associated with an increased risk of late aorta reintervention and distal aortic dilatation.

1-Year Follow-Up Study of Preemptive TEVAR for Residually Dissected Aortas after Proximal Open Repair of Acute Type A Aortic Dissection in High-Risk Patients for Late Re-Intervention

Introduction - Disease progression often occurs in residually dissected aorta after proximal open repair of acute type A aortic dissection (ATAD), requiring distal reoperations, with high mortality and morbidity(1). Unlike type B dissection, the efficacy of preemptive thoracic endovascular aneurysm repair (TEVAR) on the residual disease remains to be seen. We hypothesized that patients who were likely to develop late aneurysmal dilatation of false lumen would benefit from this preemptive approach. Methods - Initially, to analyze risk factors for late aortic events, 108 patients who survived proximal repair for ATAD from 2001 to 2010 were reviewed. During mean follow-up of 40 months, 12 patients required 14 distal re-interventions. On statistic analysis, we identified age < 60 years (p<0.01), aortic diameter > 46mm (p<0.01), and patent false lumen (p<0.05) as factors that predisposed patients who underwent the proximal repair to require late re-interventions. In 2015, we began performing preemptive TEVARs. From April 2015 to January 2016, 11 patients (mean age, 56 years; 72% men) who met the criterion of the aforementioned 3 risk factors underwent preemptive TEVARs. Devices used consisted of a proximal covered stent graft and a distal bare metal stent (Zenith Dissection Endovascular system). Simultaneously, subclavian revascularization was performed in 4 patients and 2 debranching in 2 patients. The interval between proximal repair and TEVAR averaged 122 days (range, 50-297). All patients received 12-month surveillance, including computed tomography (CT). Results - Successful graft deployment and coverage of the primary entry tear was achieved in all patients with no early deaths or intraprocedural conversions. One patient required coil occlusion of the left subclavian artery 5 days post-procedure for retrograde perfusion of the false lumen. No other serious adverse events occurred within 12 months. Survival was 100% at 1 year. Surveillance CT data showed the false lumen was completely (n=8) or partially (n=3) thrombosed in the thoracic aorta at the 12-month visit. Of the 7 patients who underwent the preemptive TEVAR within 3 months, all had complete false lumen thrombosis at the thoracic level. Six of the 7 patients experienced complete shrinkage of false lumen of the thoracic aorta. From pre-treatment to the 12-month visit, the average true lumen area increased by 203 mm2 (p<0.01), and the average false lumen decreased by 276mm2 (p<0.05), at the level of the maximum aortic diameter. Conclusion - TEVAR for residually dissected aortas after proximal open repair of acute type A aortic dissection can be done with a high rate of thoracic aortic remodeling in high-risk patients for late re-intervention. Especially, results of TEVAR within 3 months after open repair are promising. The encouraging results will stimulate further research to define the utility of the preemptive TEVAR. References(1)Geirsson A, Bavaria JE, Swarr D, Keane MG, Woo YJ, Szeto WY, Pochettino A. Fate of the residual distal and proximal aorta after acute type A dissection repair using a contemporary surgical reconstruction algorithm. Ann Thorac Surg 2007:84;1955-64.

Surgical treatment of acute aortic dissection Stanford type A in the third trimester of pregnancy: A case report.

BackgroundAortic dissection is rare in pregnancy, but it is often life-threatening. Thus, early diagnosis and optimal treatment are crucial. In addition, regular multidisciplinary care plays an important role in improving the therapeutic outcome.CaseA 31-year-old pregnant woman (gravida 2, para 1, abortus 0) was transferred to our centre at 34 weeks of gestation with onset of dyspnoea and serious chest pain radiating to her back. Ultrasonography unexpectedly revealed a dilation of the aortic root with a sign of dissection. Computed tomography confirmed a type A aortic dissection based on the Stanford classification. She was successfully treated by caesarean section prior to open repair of acute type A dissection and received multidisciplinary care. The patient was discharged on the 16th postoperative day, and the baby is still alive without adverse events.ConclusionAortic dissection in pregnancy is relatively rare, but physicians should be on high alert for the condition when a pregnant woman has chest pain. Early diagnosis and adequate treatment in addition to regular multidisciplinary care are crucial to achieve favourable results.

Is previous cardiac surgery a risk factor for open repair of acute type A aortic dissection?

ObjectiveThe study objective was to determine the optimal treatment for patients with acute type A aortic dissection and previous cardiac surgery. MethodsA total of 545 patients underwent open repair of an acute type A aortic dissection (July 1996 to January 2017), including patients with (n = 50) and without previous cardiac surgery (n = 495). Data were collected through the University of Michigan Cardiac Surgery Data Warehouse, medical record review, and the National Death Index database. ResultsCompared with patients without previous cardiac surgery, patients with previous cardiac surgery were older (62 vs 59 years, P = .24) and had significantly more coronary artery disease (48% vs 14%, P < .001), peripheral arterial disease (24% vs 11%, P = .01), connective tissue disorders (15% vs 4.5%, P = .004), and acute renal failure on presentation (28% vs 15%, P = .02); and significantly more concomitant mitral or tricuspid procedures, longer cardiopulmonary bypass time, and more intraoperative blood transfusions. There were no statistically significant differences in postoperative major complications between previous cardiac surgery and no previous cardiac surgery groups, including stroke, myocardial infarction, new-onset dialysis, and 30-day mortality (8.9% vs 6.3%, P = .55). Multivariable logistic model showed the significant risk factors for operative mortality were cardiogenic shock (odds ratio, 9.6; P < .0001) and male gender (odds ratio, 3.7; P = .006). The 5- and 10-year unadjusted survivals were significantly lower in the previous cardiac surgery group compared with the no previous cardiac surgery group (66% vs 80% and 42% vs 66%, respectively, P = .02). However, previous cardiac surgery itself was not a significant risk factor for operative mortality (odds ratio, 1.6; P = .36) or all-time mortality (hazard ratio, 1.3; P = .33). ConclusionsAcute type A aortic dissection in patients with previous cardiac surgery can be repaired with favorable operative mortality and long-term survival, and should be treated surgically.

Propensity and impact of autologous platelet rich plasma use in acute type A dissection

BackgroundCoagulopathy in patients undergoing open repair of acute type A aortic dissection using cardiopulmonary bypass and hypothermic circulatory arrest is a common complication. Autologous platelet rich plasma is an intraoperative blood conservation technique, which has been shown in previous studies to promote hemostasis, leading to a reduction of blood product transfusions during elective aortic surgery. The purpose of this study is to evaluate the effectiveness of autologous platelet rich plasma as a blood conservation technique during open surgical repair of acute type A aortic dissection. MethodsWe reviewed all acute type A aortic dissection cases using hypothermic circulatory arrest, excluding patients presenting in extremis. Perioperative transfusion requirements and clinical outcomes were analyzed. The end points analyzed included early mortality, postoperative stroke, renal dysfunction, prolonged ventilation, coagulopathy, and length of postoperative intensive care unit stay. Parsimonious and saturated propensity scores were calculated for platelet rich plasma use, and all outcomes were propensity adjusted. ResultsBetween 2003 and 2014, 85 of 391 acute type A aortic dissection repairs used autologous platelet rich plasma. Mean age of patients was 58 ± 15 years, and 70% were male. Obstructive sleep apnea (22% vs 13%, P = .04) and baseline ejection fraction (57% ± 6.7% vs 55% ± 10%; P = .014) were higher in the autologous platelet rich plasma group. Intraoperative propensity-adjusted blood products, 2 units fewer packed red blood cells (P = .001), 4 units fewer fresh-frozen plasma (P = .001), 6 units fewer platelets (P = .001), 1.3 units fewer cell-savers (P = .002), and 5 units fewer cryoprecipitate (P = .001) were significantly reduced by autologous platelet rich plasma use. Significant unadjusted reduction in postoperative reoperation for bleeding (8% vs 17%, P = .046) after autologous platelet rich plasma was reported, although propensity adjustment eliminated significance (P = .079). No difference in stroke, cardiac, or renal complications was observed. Postoperative transfusion needed during the first 3 days was significantly reduced in the autologous platelet rich plasma group: 2 units fewer packed red blood cells (P = .13), 2 units fewer fresh-frozen plasma (P = .018), and 5 units fewer platelets (P = .001), when compared with those without autologous platelet rich plasma. Ventilation time was reduced by 3 days (P = .002), and intensive care length of stay was reduced by 3 days (P = .063) after intraoperative autologous platelet rich plasma use. ConclusionsThe use of autologous platelet rich plasma in patients undergoing open repair of acute type A aortic dissection was associated with a reduction in intraoperative and postoperative blood transfusions, as well as decreased early postoperative morbidity.

Time-to-operation does not predict outcome in acute type A aortic dissection complicated by neurologic injury at presentation

ObjectiveNeurologic injury complicating the presentation of acute type A aortic dissection remains a challenge for cardiac surgeons. MethodsThis was a retrospective review of patients undergoing open repair of acute type A aortic dissection at our institution between January 2005 and December 2015. Evidence of neurologic injury at the time of presentation was abstracted from the medical record. Propensity-score matching was used to account for baseline differences between groups, and outcome analysis was performed using logistic regression and Kaplan-Meier analysis. Among patients with persistent neurologic deficits, a threshold for time-to-operation was evaluated using receiver operating characteristic curves. ResultsThere were 345 patients who underwent open repair for acute type A aortic dissection; 50 patients presented with neurologic injury. In the matched analysis, in-hospital mortality was greater among patients who presented with neurologic deficits (odds ratio, 4.42; 95% confidence interval, 1.15-16.97; P = .03). Among patients with persistent neurologic deficits at presentation, receiver operating characteristic curve analysis with cross-validation suggested that time-to-operation was a poor predictor of both neurologic outcome (area under the curve, 0.40) and death (area under the curve, 0.49). ConclusionsNeurologic injury at the time of presentation with acute type A aortic dissection was associated with an increased risk of in-hospital mortality. Among patients with persistent neurological deficits, time-to-operation failed to predict either neurologic outcome or perioperative mortality suggesting that longer time from onset of symptoms of neurologic injury should not act as a contraindication to proceeding to the operating room for expedient repair.

Reprint of: Early and late outcomes of acute type A aortic dissection with intramural hematoma

Controversy remains regarding management of acute type A dissection with intramural hematoma (IMH). Our purpose was to analyze our experience and report outcomes after repair of acute type A aortic dissection with IMH. We analyzed all patients from a single center who underwent open repair for acute type A aortic dissection with IMH. Between 2000 and 2013, we performed 418 repairs for acute type A aortic dissection. These were divided into 2 groups of patients: 64 patients (15%) with type A IMH and 354 patients (85%) with typical dissection. Those with IMH were older (62.4 ± 13.9 years vs 56.7 ± 14.7 years; P<.0046) and presented with reduced renal function (ie, glomerular filtration rate) (P<.0341), less frequently with distal malperfusion, and less frequently with rupture (P<.0116). With IMH, the time from presentation to repair was, by strategy, longer (median, 67 vs 6 hours; P<.0001), but no mortality occurred within 3 days of presentation. Mortality with IMH did not differ from typical dissection: 7 out of 64 patients (10.9%) versus 52 out of 354 patients (14.7%; P=.4276). A lower incidence of postoperative dialysis in the IMH group approached significance: 6 out of 63 patients (9.5%) versus 64 out of 347 patients (18.4%; P=.0820). When adjusted for age and renal function, late survival was improved with IMH (P<.0343). Repair of acute type A aortic dissection with IMH is associated with significant early morbidity and mortality, differing minimally from typical aortic dissection. Although expectant repair within 3 days may be applied, the purposeful delay imparted little advantage. Improved late outcomes may be seen with IMH, but continued long-term surveillance is required for verification.

Early and late outcomes of acute type A aortic dissection with intramural hematoma

Controversy remains regarding management of acute type A dissection with intramural hematoma (IMH). Our purpose was to analyze our experience and report outcomes after repair of acute type A aortic dissection with IMH. We analyzed all patients from a single center who underwent open repair for acute type A aortic dissection with IMH. Between 2000 and 2013, we performed 418 repairs for acute type A aortic dissection. These were divided into 2 groups of patients: 64 patients (15%) with type A IMH and 354 patients (85%) with typical dissection. Those with IMH were older (62.4 ± 13.9 years vs 56.7 ± 14.7 years; P<.0046) and presented with reduced renal function (ie, glomerular filtration rate) (P<.0341), less frequently with distal malperfusion, and less frequently with rupture (P<.0116). With IMH, the time from presentation to repair was, by strategy, longer (median, 67 vs 6 hours; P<.0001), but no mortality occurred within 3 days of presentation. Mortality with IMH did not differ from typical dissection: 7 out of 64 patients (10.9%) versus 52 out of 354 patients (14.7%; P=.4276). A lower incidence of postoperative dialysis in the IMH group approached significance: 6 out of 63 patients (9.5%) versus 64 out of 347 patients (18.4%; P=.0820). When adjusted for age and renal function, late survival was improved with IMH (P<.0343). Repair of acute type A aortic dissection with IMH is associated with significant early morbidity and mortality, differing minimally from typical aortic dissection. Although expectant repair within 3 days may be applied, the purposeful delay imparted little advantage. Improved late outcomes may be seen with IMH, but continued long-term surveillance is required for verification.

Endovascular Approaches to Acute Aortic Type A Dissection: A CT-Based Feasibility Study

Background Open graft replacement of the ascending aorta is the current treatment of choice for Stanford acute type A dissections. However, approximately 20% of patients are deemed unfit for open surgery. To determine if an endovascular option exists for this latter group of patients, we performed a computed tomography (CT)-based feasibility study. Methods A cohort of consecutive patients presenting to the cardiovascular care unit (CVCU) for an acute Stanford type A aortic dissection between 2006 and 2009 was retrospectively analysed. Inclusion criterion was a high-quality preoperative angio-CT scan that could be analysed on a three-dimensional (3D) workstation. Numerous anatomical parameters of the dissection were studied, including the location and the length of the primary proximal entry tear. Finally, we determined which of the patients would have been potential candidates for an endovascular repair (stentgraft implantation). Results A total of 102 patients were included in our study. The median distance of the primary entry tear to the closest coronary artery was 23 mm (range 0–128). The median true lumen and true + false lumen (total) diameters at the level of the entry tear was 38 mm (range 22–78) and 46 mm (range 28–93), respectively. The median length of the ascending aorta was 84 mm (range 40–130). An endovascular repair with a tubular stentgraft was deemed feasible in 37 patients. An additional eight patients were also candidates for a tubular endovascular repair but would have required a carotidecarotid cross over bypass. Finally, an arch-branched stentgraft could have been used in 13 patients to exclude an entry tear located in the arch. Conclusion Open repair of acute type A dissection is and remains the ‘gold standard’ of care. Our study demonstrates that approximately half the patients undergoing an open repair could potentially benefit from an endovascular repair. This new treatment option has not been evaluated to date.

Long-term results of percutaneous management of malperfusion in acute type B aortic dissection: Implications for thoracic aortic endovascular repair

Open repair for acute type B dissection with malperfusion is associated with significant morbidity. Thoracic aortic endovascular repair has been proposed as a less-invasive therapy for acute type B dissection with malperfusion. Benefits of thoracic aortic endovascular repair include the potential for false lumen thrombosis. Its risks include both early morbidity and mortality, and uncertain late results with potentially unstable landing zones. We present the first long-term analysis of an alternative endovascular approach consisting of percutaneous flap fenestration with true lumen and branch vessel stenting to restore end-organ perfusion. Outcomes were analyzed for 69 patients presenting with acute type B dissection with malperfusion from 1997 to 2008. All patients were evaluated with angiography and treated with a combination of flap fenestration, true lumen, or branch vessel stenting where appropriate. Mean age was 57.3 years. Identified malperfused vascular beds included spinal cord (5), mesenteric (40), renal (51), and lower extremity (47). Major morbidity included dialysis need (11), stroke (3), paralysis (2), and 30-day mortality (n = 12, 17.4%). Mean Kaplan-Meier survival was 84.3 months. Although late mortality was associated with age (P < .0001), neither the type nor the number of malperfused vascular beds correlated with vital status at last follow-up (P > .4). Freedom from aortic rupture or open repair at 1, 5, and 8 years was 80.2%, 67.7%, and 54.2%, respectively. Presentation with acute type B dissection with malperfusion carries a significant risk for both early and late mortality. Percutaneous approaches allow for rapid restoration of end-organ perfusion with acceptable results. These long-term results can serve as comparative data by which to evaluate newer therapies for acute type B dissection with malperfusion, such as thoracic aortic endovascular repair.