Downstream Remodeling after type-A Aortic Dissection Repair Using a Novel Noncovered Stent Prosthesis: A Computer Tomography Analysis

Background: This study reports downstream remodeling after type-A aortic dissection treated with a novel noncovered stent prosthesis assessed using computed tomography analysis. Aortic remodeling is associated with patient survival, and there is currently a lack of comprehensive research on mid- to long-term outcomes with the novel noncovered stent prothesis.

Methods: Between 08/2019 and 04/2022, 34 patients underwent emergent surgical aortic repair with a novel noncovered stent prosthesis with additional ascending aortic 61,8% (21) and root replacement 38,2% (13). Follow-up computer tomography, conducted at a minimum of one-year postsurgery, was accessible for 24 of these patients, all of whom were included in the study. The average duration of follow-up was 794 days. The evaluation of aortic remodeling involved precise measurements of aortic and true lumen diameters, assessment of the false lumen area, and determination of the false lumen status at aortic zones from 0 to 9. The assessments were conducted using two approaches: for each zone separately and for each patient individually. Aortic remodeling outcomes were then categorized into three distinct groups: positive, neutral, and negative.

Results: Implantation of the prosthesis was performed in zone 0 in 58.3% (14), zone 1 in 25% (6), and in zone 2 in 16,7% (4) of patients. Regarding entry tear localization, E1 (ascending aorta) occurred in 54,2% (13), E2 (arch) in 41,7% (10), and E3 (descending aorta) in 4,1% (1).

Positive remodeling was observed in 20,8% (5) of patients and in aortic zones 1 and 2, while occurred neutral in 29.2% (7) and in zones 0 and 3. Negative remodeling was prevalent in 50% (12) of patients and in zones 4–9. Remodeling of the aorta was independent of re-entry or prosthesis implantation zone.

In-hospital mortality and the postoperative apoplexy rate were 11.5% (4) and 12.5% (3), respectively. Preoperative malperfusion was observed in 20,8% (5), with 8,3% (2) experiencing M2 (supra-aortic) and 12,5% (3) M3 (spinal/visceral/iliac). Postoperatively, malperfusion was reduced to 8.3% (2) (p = 0.250) overall.

Conclusion: Positive remodeling occurred infrequently, while negative and neutral remodeling were more common during the early to mid-term follow-up. The novel stent graft for aortic dissections adds to the surgeon's options, particularly for managing malperfusion, but it does not have a clear positive impact on the early to mid-term remodeling process.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
13 February 2024