Objective

This study aims to investigate the clinical manifestations, operative techniques, and outcomes of patients who undergo open repair after thoracic endovascular aortic repair (TEVAR).

Methods

From January 2010 to June 2022, 113 consecutive type A aortic dissection (TAAD) patients underwent secondary open operation after TEVAR at our institution, and the median interval from primary intervention to open surgery was 12 (1.9–48.0) months. We divided the patients into two groups (RTAD (retrograde type A dissection) group, N = 56; PNAD (proximal new aortic dissection) group, N = 57) according to their anatomical features. Survival analysis during the follow-up was evaluated using a Kaplan–Meier survival curve and a log-rank test.

Results

The 30-day mortality was 6.2% (7/113), the median follow-up period was 31.7 (IQR 14.7–65.6) months, and the overall survival at 1 year, 5 years, and 10 years was 88.5%, 88.5%, and 87.6%, respectively. Fourteen deaths occurred during the follow-up, but there were no late aorta-related deaths. Three patients underwent total thoracoabdominal aortic replacement 1 year after a second open operation. The RTAD group had a smaller ascending aorta size (42.5 ± 7.7 mm vs 48.4 ± 11.4 mm; P < .01) and a closer proximal landing zone (P < .01) compared to the PNAD group. However, there were no differences in survival between the two groups.

Conclusions

TAAD can present as an early or a late complication after TEVAR due to stent-grafting-related issues or disease progression. Open operation can be performed to treat TAAD, and this has acceptable early and mid-term outcomes. Follow-up should become mandatory for patients after TEVAR because these patients are at increased risk for TAAD.

中文翻译：

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主动脉腔内修复术后 A 型主动脉夹层的手术治疗：一项为期 12 年的单中心研究

客观的

本研究旨在探讨胸主动脉腔内修复术（TEVAR）后接受开放式修复术的患者的临床表现、手术技术和结局。

方法

2010年1月至2022年6月，我院连续113例A型主动脉夹层（TAAD）患者在TEVAR后接受二次开放手术，从初次干预到开放手术的中位间隔为12（1.9-48.0）个月。 我们根据患者的解剖特征将患者分为两组（RTAD（逆行A型夹层）组，N  = 56；PNAD（近端新主动脉夹层）组，N = 57）。使用 Kaplan-Meier 生存曲线和对数秩检验评估随访期间的生存分析。

结果

30天死亡率为6.2%（7/113），中位随访时间为31.7（IQR 14.7-65.6）个月，1年、5年和10年总生存率为88.5%、88.5% 、 和 87.6% 。随访期间发生 14 例死亡，但没有出现与主动脉相关的晚期死亡。三名患者在第二次开放手术一年后接受了全胸腹主动脉置换术。 与 PNAD 组相比，RTAD 组的升主动脉尺寸较小（42.5 ± 7.7 mm vs 48.4 ± 11.4 mm；P  < .01），且近端着陆区更近（P < .01）。然而，两组之间的生存率没有差异。

结论

由于支架移植相关问题或疾病进展，TAAD 可能表现为 TEVAR 后的早期或晚期并发症。TAAD可采用开放手术治疗，早中期疗效可接受。TEVAR 后患者应强制随访，因为这些患者发生 TAAD 的风险增加。