SS17 - Long term Outcomes from the Society for Vascular Surgery Vascular Quality Initiative Thoracic Endovascular Aortic Repair for Type B Aortic Dissection project

Objectives: The SVS VQI TEVAR for Dissection Surveillance Project was created to evaluate outcomes after treatment of Type B Aortic Dissection (TBAD) using a real-world registry. The 5-year results are reported below.

Methods: Acute dissections (AD) were defined as < 30 days, and acute complicated (AC) dissections were those presenting with malperfusion or rupture. The acute uncomplicated (AUC) dissection patients were further subdivided into groups per the SVS/STS Reporting Standards for TBAD: 1)Hyperacute( < 24 hours); 2)Acute(1-14 days); 3)Subacute(15-90 days). Summary statistics were performed for group comparisons, and Kaplan-Meier analysis was performed for survival and freedom from reintervention.

Results: There were 516 patients included in this analysis. Compared to chronic dissection (CD) patients, AD patients were younger (57 vs.61, p< 0.001), more often transferred (73.2% vs.16.7%, p< 0.001), more often operated on in an urgent fashion (70.6% vs.18.7%, p< 0.001), and less likely to have had prior aortic surgery (5.3% vs.19.9%, p< 0.001). The AD patients had more proximal zones of disease compared to CD patients (Zone 2/3-91.0% vs.74.5%, p< 0.001), and smaller aortic diameters (42.1mm vs.51.3mm, p< 0.001). There were no differences in 5-year rates of any SCI, disabling stroke, renal failure, or RTAD between AD vs. CD groups. The overall 5-year mortality rate was 8.5%, and was higher in the AD compared to CD cohorts (11.8% vs.5.0%, p=0.006, Figure 1), whereas the overall 5-year reintervention rate was 29.4%, which was no different between cohorts (32.5% vs.26.3%, p=0.195, Figure 2). In evaluating the AD patients separately, the AC patients had a higher 5-year mortality, (17.6% vs.7.4%, p=0.008) as well as rate of disabling stroke (5.1% vs.0.7%, p=0.046), but no differences in reinterventions compared to the AUC group. Reinterventions were performed more frequently for aortic enlargement, false lumen perfusion and extension of dissection in AUC patients, and more often for malperfusion in the AC group. In evaluating AUC patients by timing of intervention, there were no differences in mortality or the need for reintervention amongst groups.

Conclusions: The long-term results from the SVS VQI TEVAR for Dissection Surveillance project show that the 5-year mortality rate is higher for AD vs.CD patients, and within the AD cohort, was higher amongst the AC cohort. The need for reintervention was high regardless of the timing of intervention, although the indications for reintervention differed. These data further our understanding of the outcomes of TEVAR for the treatment of TBAD, by timing.