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Gore Thoracic Branch Endoprosthesis Early Outcomes And Graft Sizing In Dissection And Intramural Hematoma
Mackenzie Snyder, MD1, Grant Killian, BS
2, Saima Shafique, PhD
1, Rithvik Gundlapalli, BA
2, Khalid Elhadi, BS
2, Molly Sternick, MD
1, Ryan Lim, MD
1, Kendal Endicott, MD
1.
1INOVA Fairfax, Falls Church, VA, USA,
2University of Virginia School of Medicine, Charlottesville, VA, USA.
OBJECTIVES: Objective: The GORE Thoracic Branch Endoprosthesis (TBE) is a single-branch thoracic endograft enabling endovascular preservation of the left subclavian artery in the treatment of thoracic aortic pathology. Data regarding early clinical outcomes in aortic dissection (AD) and intramural hematoma (IMH) with specifics related to graft sizing is currently limited.
METHODS: From September 2022 to July 2025, 79 zone II TBEs were implanted at a single institution. Pathology included Type IIIA/B AD and IMH in 49 patients (hyperacute (n=2), acute (n=39), subacute (n=8)). 30 patients were treated for other indications including chronic dissection (n=11), aneurysm (n=6), saccular aneurysm or penetrating aortic ulcer (n=9), trauma (n=2), and Kommerell’s diverticulum (n=2). Within the AD/IMH group, the TBE was utilized for treatment of residual dissection status post zone II arch repair in 19 patients. Patient demographics, landing zone sizing, intraoperative variables, and 30-day post operative outcomes were compared between the AD/IMH and other group using Pearson’s chi square test for categorical variables and independent sample t-test for continuous variables.
RESULTS: Pre-operative characteristics of the AD/IMH group versus other pathology did not differ significantly except for increased coronary artery disease in the non-AD/IMH group (p=0.024). There was one incidence of post-operative spinal cord ischemia and one stroke overall. There were no retrograde aortic dissections. In the AD/IMH cohort, antegrade filling of the false lumen was observed in three cases, two of which resolved at 30-day imaging. 30-day mortality for the entire cohort was 5.1%, of which all deaths occurred in the non-AD/IMH group. In the entire cohort, stent graft oversizing was not significantly different between the two groups (17.6% v 18.3%, p =0.77). In the native zone II landings, 91.7% of graft sizing followed manufacturer instructions-for-use for the TBE graft with 5 cases being undersized. In this cohort, an average of 14.8% oversizing was utilized. When landed into a proximal arch reconstruction, 30.0% graft oversizing was observed.
CONCLUSIONS: Utilization of the TBE graft in AD and IMH resulted in similarly low short-term complications as compared to other pathology. Graft oversizing within the device manufacturer instructions-for-use demonstrated zero incidence of retrograde dissection.
Interoperative Characteristics Overall and by Comparison | All patients (n=79) | Acute Dissection + IMH n=49) | All other TBE indications (n=30) |
| Operative Time (min) | 69 [57 - 101] | 63 [55 - 82] | 87.5 [62.75 - 143] |
| Fluro Time (min) | 19.6 [15.6 - 29.1] | 18.5 [14.72 - 23.37] | 24.5 [17.95 - 41. 0] |
| TBE Graft Size (mm) | 36 [34 - 37] | 34 [34 - 37] | 37 [34 - 37.75] |
| Zone II Diameter (mm) | 30 [28 - 33] | 30 [28 - 33] | 30.5 [28 - 35] |
| Iliac Stent for Rupture | 3 (3.8) | 1 (2.0) | 2 (6.7) |
| Percent Oversized (%) | 17.9 [11.1-23.3] | 17.6 [11.1-21.9] | 18.3 [11.7-23.3] |
| Percent Oversized in Native Zone 2 Landing (%) | 14.1 [10.7-17.8] | 14.7[9.9-17.2] | 13.1 [10.7-18.1] |
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