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Impact Of Aortic Visceral Branch Vessel Interventions On The Postoperative Outcomes Of Type B Aortic Dissection Complicated With Visceral Malperfusion
Narek Veranyan, MD
1, Gregory A. Magee, MD
2, Jeffrey J. Siracuse, MD, MBA
3, Ann Gaffey, MD, MS
1, Mahmoud B. Malas, MD, MHS
1.
1UC San Diego Health, La Jolla, CA, USA,
2Keck Medicine of University of Southern California, Los Angeles, CA, USA,
3Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA.
OBJECTIVES: TEVAR is the standard of care for TBAD complicated with visceral malperfusion. By covering the intimal tear TEVAR redirects the blood flow into the true lumen and helps resolve visceral malperfusion. However, a subset of patients might require additional visceral branch vessel (VBV) interventions to maintain perfusion. This study aims to compare the postoperative outcomes of TEVAR with vs without (VBV) interventions.
METHODS: The Vascular Quality Initiative (VQI) database was reviewed for patients who underwent TEVAR for TBAD complicated with intestinal or renal malperfusion. The cohort was divided into two groups: with vs without VBV intervention. VBV intervention was defined as any additional interventions to maintain blood flow to the celiac artery (CA), superior mesenteric artery (SMA), right renal artery (RRA), or left renal artery (LRA). Baseline demographic, clinical, and perioperative characteristics, as well as outcomes such as 30-day mortality, disease/treatment-related mortality, and Major Adverse Cardiovascular Events (MACE: death, MI, stroke), were compared between the two groups. Univariable and multivariable analysis was conducted.
RESULTS: There were 551 patients included in the final analysis, of which 386 (70.1%) underwent TEVAR without VBV intervention, whereas 165 (29.9%) underwent TEVAR with intervention. There were few differences in baseline characteristics between the two groups (Figure 1). After adjustment for potential confounders, TEVAR with VBV intervention was associated with lower odds of 30-day mortality (OR: 0.45, 95%CI: 0.23-0.88, p=0.020), disease/treatment-related mortality (OR: 0.39, 95%CI: 0.18-0.85, p=0.018), and MACE (OR: 0.55, 95%CI: 0.33-0.94, p=0.028), (Figure 2).
CONCLUSIONS: In this real-world multi-institutional study, TEVAR with VBV intervention is associated with a significant reduction in 30-day overall mortality, disease/treatment-related mortality, and MACE in TBAD patients presenting with visceral malperfusion. The important role of adjunctive visceral branch intervention with TEVAR in the resolution of visceral malperfusion needs to be revisited. A prospective study is required to confirm these findings.
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