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At 3 years, patients with acute aortic dissection continue to benefit from stent graft
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LAS VEGAS — Patients with acute complicated type B aortic dissection mostly had good outcomes at 3 years, according to results presented at VIVA 16.
The DISSECTION Investigational Device Exemption trial enrolled 50 patients (mean age, 57 years; 80% men; 62% white) from 16 U.S. centers with acute complicated type B aortic dissection to evaluate outcomes associated with the thoracic stent graft (Valiant Captiva, Medtronic).
Patients will be followed to 5 years; 2-year results were presented at VIVA 15 and 3-year results were presented here by Ali Azizzadeh, MD, from Memorial Hermann Heart & Vascular Institute, Houston.
At 3 years, there were 32 patients eligible for follow-up and 28 completed follow-up.
Azizzadeh said there were no ruptures or conversions to open repair.
Also, at the 3-year mark, true lumen diameter over the endograft segment was stable or rose in 92.3% of the cohort, whereas false lumen diameter was stable or decreased in 69.3% and the false lumen was thrombosed to some extent in 75%, he said.
There was one death between 2 and 3 years, which was from sepsis and adjudicated as not related to the device, procedure or dissection, he said.
The 3-year rate of freedom from all-cause mortality was 79.4% and the 3-year rate of freedom from dissection-related mortality was 90%, according to the researchers.
There were no serious adverse events between year 2 and year 3, Azizzadeh said.
“There were low rates of secondary endovascular procedures and favorable aortic remodeling over the stented segment,” Azizzadeh said at a press conference. – by Erik Swain
Reference:
Azizzadeh A, et al. Late-Breaking Clinical Trials. Presented at: VIVA 16; Sept. 18-22, 2016; Las Vegas.
Disclosure : The study was funded by Medtronic. Azizzadeh reports consulting for and receiving research funding from Medtronic and W.L. Gore and Associates.
Perspective
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Michael R. Jaff, DO, FSCAI
I am overwhelmed by the success of this technology in treating such a morbid and mortal disease. The only other option we really have for these patients is an open surgical procedure with high morbidity and mortality. Patients did remarkably well with this therapy. It’s heartening to know that this technology is working out to such a huge advantage for these patients. It helps that the doctors are getting a lot better technically with the procedure. The results can be attributed to a combination of patient selection, physician expertise and experience, and technology improvement.
In the future, we should see procedures more proximal in the aortic arch, managing with the great vessels.
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