Multi-Layer Flow-modulating Stents for the Treatment of Thoracoabdominal Aortic Dissections, 55th Annual Meeting, Abstract Book,The Society of Toracic Surgeons – STS, San Diego, CA, USA, January 27-29 2019
Presentation Title: Multi-layer Flow-modulating Stents for the Treatment of Thoracoabdominal Aortic Dissections
Abstract Purpose: Treatment of thoracoabdominal aortic dissections (TAAD) frequently requires open repair with increased procedural risk. Conventional endovascular prostheses have had limited success in repairing TAAD due to inadequate fenestration coverage and inability to maintain branch vessel flow. We evaluated the outcomes of patients with TAAD treated with multi-layer flow-modulating (MFM) stents. Abstract Methods: A retrospective analysis of a prospectively maintained institutional database was undertaken for all patients with TAAD treated with MFM stents (n=21) between April 2014 and July 2018. Outcome data were collected including stroke, paraplegia, branch vessel patency, endoleaks, degree of aortic remodeling, and death. Patients were followed with annual computed tomography angiography (CTA) scans and regular telephone interviews. Morphologic computational fluid dynamics (CFD) analysis of CTA scans was performed using Mimics and Ansys software to assess aortic remodeling as defined as a reduction in total aortic length along with changes to the volume and diameters of the true and false lumens. Abstract Results: M:F ratio was 16:5. Mean age was 49 years (27-73 years). Indications for treatment included chronic Type B aortic dissection (n=15), prior Type A dissection repair with false lumen expansion (n=5) and distal malperfusion post-acute Type A dissection repair (n=1). Proximal landing zones were: Zone 0 (n=17), Zone 2 (n=3) and Zone 2 (n=1). Seventy-two stents were used (mean 3.42 devices/patient) and 136 branch vessels were covered. Procedural success was 100% with no strokes, paraplegia, acute kidney injuries, endoleaks or deaths. There was one reintervention for an access sheath-related iliac artery dissection. Follow-up was available for all patients (average 18 months; range of 1-51 months). At 3-years, branch vessel patency was 100% and therewere no aortic-related deaths. (Figure 1) Two patients died from non-aortic related causes subsequent to their 2-year follow-up imaging. Positive aortic remodeling (reduction in volume and diameter of the false lumen) was observed in all patients.
Abstract Conclusions: MFM stents appear to provide a safe treatment option for TAAD patients, with low-risk of complications. Patency is preserved to covered aortic arch and visceral side-branches and positive aortic remodeling is observed in the short-term. Additional study is needed to better understand the role of MFM stents in the management of TAAD.
Identify the source of the funding for this research project: The Competitiveness Operational Program 2014-2020, financed from European Regional Development Fund and by the Romanian Government under the project “Next generation computer-aided research in cardiovascular disease management”-NEXTCardio.