Joseph V. Lombardi1, Richard P. Cambria2, Christoph Nienaber3, Roberto Chiesa4, Omkee Teebken5, Anthony Lee6, Peter Mossop7, Stéphan Haulon8, Qing Zhou9, Feiyi Jia9
1Surgery, Cooper University Hospital, Camden, NJ; 2Massachusetts General Hospital, Boston, MA; 3University Hospital Rostock, Rostock, Germany; 4Hospital San Raffaele, Milano, Italy; 5Hanover Medical School, Hannover, Germany; 6Christine E Lynn Heart and Vascular Institute, Boca Raton, FL; 7St. Vincent's Hosptal, Melbourne, VIC, Australia; 8Chirurgie Vasculaire, Hospital Cardiologique, Chru de Lille, Lille, France; 9Med Institutel, West Lafayette, IN.
OBJECTIVES: We report aortic remodeling from the STABLE trial, a prospective, multicenter study evaluating safety and effectiveness of a pathology-specific endovascular system (proximal stent-graft and distal bare metal stent) for the treatment of complicated type B aortic dissection (cTBAD).
METHODS: All 86 enrolled patients (mean age 59 years; 73% male) were treated within 90 days of symptom onset (64% treated within 14 days). Aortic remodeling through 2 years was assessed in patients with available aortic size data (as of April 2012).
RESULTS: The 30-day mortality rate was 4.7% (4/86); patient survival was 88% at 1 year and 85% at 2 years. From baseline to 2 years (Figure 1), the true lumen diameter increased significantly in the descending thoracic aorta (DTA) and the more distal abdominal aorta (AA), with a concomitant decrease in false lumen diameter. Transaortic growth (>5mm) occurring at any time within 2 years was observed in the DTA in 21 patients and in the AA in 21 patients; a majority of these patients had acute dissection (17/21 for DTA, 20/21 for AA). Mortality, rupture, conversion and secondary intervention were not significantly different between patients with and without transaortic growth. A generalized linear model indicates that a shorter time from symptom onset to treatment predicts transaortic growth in both the DTA (p=0.03) and AA (p<0.001), and a higher SVS risk score for hypertension predicts growth in the AA (p=0.04).
CONCLUSIONS: Endovascular repair of cTBAD using a composite construct demonstrates favorable aortic remodeling. However, patients treated in the acute setting may be prone to aortic growth and require close observation. Follow-up through 5 years is ongoing.
AUTHOR DISCLOSURES: R. P. Cambria: Cook Medical, Research grants; R. Chiesa: Nothing to disclose; S. Haulon: Cook Medical, Consulting fees or other remuneration (payment); GE Healthcare, Consulting fees or other remuneration (payment); F. Jia: Med Institute, Employment (full or part-time); A. Lee: Cook Medical, Research grants; J. V. Lombardi: Cook Medical, Research grants; P. Mossop: Cook Medical, Consulting fees or other remuneration (payment); C. Nienaber: Medtronic, Consulting fees or other remuneration (payment); Boston Scientific, Consulting fees or other remuneration (payment); Cook Medical, Honorarium; Bolton, Honorarium; Medtronic, Honorarium; O. Teebken: Bolton, Research grants; Cook Medical, Research grants; Jotec, Research grants; Cook Medical, Honorarium; Gore, Honorarium; Medtronic, Honorarium; Q. Zhou: Med Institute, Employment (full or part-time).
Posted April 2013