Weighted 10-year survival and neurological outcomes after zone 2 thoracic endovascular aortic repair for acute type B aortic dissection.

Abstract

The long-term benefits of left subclavian artery (LSA) revascularization during thoracic endovascular aortic repair (TEVAR) for patients with acute type B aortic dissection (aTBAD) remain controversial. This study aimed to evaluate the impact of LSA revascularization during TEVAR on short- and long-term survival and neurologic outcomes in patients with aTBAD. We retrospectively analyzed data from consecutive patients with aTBAD undergoing zone 2 TEVAR between 2010 and 2020 at one Chinese national aortic center. Inverse probability of treatment weighting was employed to mitigate baseline differences between LSA coverage and revascularization groups. Long-term survival, freedom from major adverse cardiovascular events (MACE), ischemic stroke rates, and cerebrovascular accident (CVA) rates were assessed using the Kaplan-Meier analysis. Weighted logistic and Cox regression models were applied to identify predictors of short- and long-term outcomes. The final analysis included 253 patients. Intergroup balance was achieved after inverse probability of treatment weighting. After LSA revascularization, incidences of postoperative type II endoleak (38.9% vs 38.2%; P = .91), post implantation syndrome (38.0% vs 38.5%; P = .938), 30-day mortality (0.6% vs 1.1%; P = .568), and early CVA (0.6% vs 0.5%; P = .931) were comparable between groups. There was no significant difference in CVA incidence (4.8% vs 12.1%; P = .34) or freedom from MACE (91.2% vs 78.5%; P = .55) at 10-year follow-up. Weighted multivariable analysis identified post implantation syndrome after TEVAR as an independent predictor of CVA (hazard ratio, 2.65; 95% confidence interval, 1.10-6.42; P = .03). LSA revascularization during TEVAR does not increase risks for perioperative or long-term morbidities. Ischemic stroke rates, CVA rates, survival, and MACE-free survival were statistically comparable between groups at 5- and 10-year follow-up. Post implantation syndrome emerged as a significant CVA risk factor after zone 2 TEVAR for aTBAD.