Long-term Outcomes of Treatment with Different Stent Grafts in Acute
DeBakey Type I Aortic Dissection
Abstract
Background: We developed an integrated triple-branched stent to treat
acute DeBakey type I aortic dissection and modified it to enhance its
adaptability. However, whether the patients treated by the modified
stent would achieve better long-term prognosis is unknown. Methods: This
study enrolled 147 patients with acute DeBakey type I aortic dissection.
The original integrated triple-branched stents were used in 57 patients
(group A) between July 2012 and August 2013, and the modified stents in
90 patients (group B) between September 2013 and March 2015. Clinical
characteristics, surgical data, postoperative complications, mortality,
and follow-up data of the two groups were analyzed. Results: The two
groups presented comparable early death rate (group A=7.0%, group
B=5.9%, p=0.719). The incidence of postoperative acute kidney injury
was lower in group B (10.0%) vs group A (24.6%) (p=0.018). Compared
with the original integrated triple-branched stent graft, the modified
stent could reduce the risk of early postoperative acute kidney injury
[OR (95%CI)=0.36(0.14, 0.94)]. Early endoleak rate was lower in
group B (1.0%) vs group A (9.4%) (p=0.004). During follow-up, there
were five deaths in group A (9.4%) and six deaths in group B (7.2%)
(p=0.646). Chronic kidney injury (7.5% vs 3.6%, p=0.311), delayed
endoleak (11.3% vs 4.8%, p=0.157), and late reinterventions (7.5% vs
2.4%, p=0.155) in the two groups were similar. Conclusions: In patients
with acute DeBakey type I aortic dissection, the modified stent could
provide feasible and safe treatment outcomes, with better protection of
kidney function and reduced early endoleak. However, they had similar
long-term effects.