Multi-center experience with an off-the-shelf single retrograde thoracic branch endoprosthesis for acute aortic pathology
Kathryn DiLosa, Michelle Manesh, Lucas Ruiter Kanamori, Mabel Chan, Gregory A. Magee, Fernando Fleischman, Jason T. Lee, Sara L. Zettervall, Matthew P. Sweet, Joel Harding, Shahab Toursavadkohi, Javairiah Fatima, Jussi M. Kärkkäinen, Sukgu M. Han, Steven Maximus
Abstract
OBJECTIVE: The thoracic branch endoprosthesis (TBE) (W.L. Gore) offers an off-the-shelf single option for thoracic endovascular aortic repair (TEVAR) of aortic arch pathology with sealing in zones 0 to 2. This study reports the early outcomes of TBE-TEVAR for acute indications. METHODS: Clinical data, imaging, and outcomes of patients treated with TBE-TEVAR at seven institutions were retrospectively reviewed (March 2017 to March 2024). Patients treated for complicated aortic dissection, symptomatic aneurysm/pseudoaneurysm, or blunt traumatic aortic injury by urgent/emergent repair were included. End points were 30-day mortality, major adverse events (mortality, myocardial infarction, prolonged intubation, stroke, paraplegia, dialysis, or bowel ischemia), and technical success. RESULTS: Of 356 patients treated by TBE-TEVAR, 107 (69.0% male; mean age, 60 ± 15 years) underwent repair for acute indications including 70 dissections (65%), 21 symptomatic aneurysms/pseudoaneurysms (20%), and 16 blunt traumatic aortic injuries (15%). Eight patients (8%) had repair immediately after open ascending repair of a type A dissection. Proximal sealing was in zone 2 in 91 patients (89%) and zone 0 to 1 in 11 patients (11%) who required cervical debranching. Technical success was achieved in all (99%) except one patient with acute dissection and aneurysmal degeneration requiring staged repair. At 30 days, two patients (2%) died, and 19 patients (18%) developed major adverse events, including stroke in six patients (6%) and paraplegia in six patients (6%). Five patients (5%; all Zone 2) had retrograde dissections, all treated for acute or subacute dissection, with no mortality. Mean follow-up was 55 ± 171 days, and 96 patients (94%) had follow-up imaging. Type IA or III endoleak occurred in seven patients (7%), retrograde branch occlusion in one (1%), and eleven (10%) required reintervention. Cumulative aortic-related mortality was three (3%) from aortic rupture. CONCLUSIONS: Urgent/emergent TEVAR with the Gore TBE device in acute pathology offers low mortality, stroke, and paraplegia risk. Longer follow-up is needed to assess effectiveness of the repair.