Outcomes from the Gore Global Registry for Endovascular Aortic Treatment in Patients Undergoing Thoracic Endovascular Aortic Repair for Type B Dissection

Objective

The Global Registry for Endovascular Aortic Treatment (GREAT) is a prospective multicenter registry collecting real-world data on the performance of W.L. Gore (Flagstaff, AZ) aortic endografts. The purpose of the present study was to analyze the implementation and outcomes of thoracic endovascular aortic repair (TEVAR) in GREAT patients with type B aortic dissection (TBAD).

Methods

From 2010 to 2016, >5,000 patients were enrolled in the GREAT from 113 centers in 14 countries across 4 continents. The study population comprised those treated for TBAD. The primary outcomes of interest were mortality and freedom from aortic events (AEs).

Results

A total of 264 patients (80% male; mean age, 62 years) underwent TEVAR for the treatment of 170 (64%) acute and 94 (36%) chronic cases of TBAD. Chronic TBAD patients required significantly longer endograft coverage than did acute TBAD patients (P = 0.05). Early postoperative complications occurred in 9% of patients, with no difference in chronic versus acute dissection (P = 0.11). The 30-day aortic mortality and all-cause mortality were 1.5% and 2.3%, respectively, with no differences based on chronicity. During a mean follow-up of 26 months, the total aortic mortality was 2.7% and the total all-cause mortality was 12.5%. The all-cause mortality was significantly greater for chronic versus acute TBAD (19.2% vs. 8.8%, respectively; P = 0.02). On multivariate analysis, patients with acute uncomplicated dissections had significantly improved overall survival compared with all other categories of dissections (93% vs. 83% at 2 years; P < 0.05). A proximal landing zone diameter >40 mm was associated with an increased risk of retrograde type A 76dissection (18% vs. 2%; P = 0.02). Patients undergoing left subclavian artery (LSA) coverage experienced a two-fold greater rate of AEs compared with noncoverage patients (P < 0.01). Patients who underwent LSA revascularization experienced a 1.5-fold greater rate of AEs compared with patients covered without revascularization (P = 0.04).

Conclusions

TEVAR for TBAD using the conformable GORE TAG thoracic endoprosthesis device can be performed with a low incidence of aortic mortality and complications. Acute uncomplicated TBAD patients had a significantly lower mortality rate than that of other patients. Larger proximal landing zones were associated with more frequent retrograde type A dissection. LSA involvement (coverage and/or revascularization) was associated with an increased risk of AEs during follow-up.