Impact of Arch Disease Pathology on Outcomes of Zone 0 Branched Thoracic Endovascular Arch Repair
Zone 0 branched thoracic endovascular arch repair (Z0BTEVAR) has emerged as an alternative to open repair for high-risk patients with aortic arch pathology. However, it is unclear how disease characteristics in this population impacts clinical outcomes. The study aimed to compare Z0BTEVAR according...
Gespeichert in:
| Veröffentlicht in: | Journal of vascular surgery 2024-12 |
|---|---|
| Hauptverfasser: | , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | |
|---|---|
| container_issue | |
| container_start_page | |
| container_title | Journal of vascular surgery |
| container_volume | |
| creator | Guo, Ming Hao Kölbel, Tilo Le Houerou, Thomas Mesnard, Thomas Sobocinski, Jonathan Nana, Petroula Haulon, Stéphan |
| description | Zone 0 branched thoracic endovascular arch repair (Z0BTEVAR) has emerged as an alternative to open repair for high-risk patients with aortic arch pathology. However, it is unclear how disease characteristics in this population impacts clinical outcomes. The study aimed to compare Z0BTEVAR according to arch disease pathology and to identify potential predictors of post-operative outcomes.
From 2011 to 2023, patients who underwent Z0BTEVAR for chronic aortic dissection (C-AD) or for non-aortic dissection (N-AD) etiology at 3 European centers were included. The primary outcome was a composite of in-hospital mortality and disabling stroke. Multivariable logistic analyses were conducted to identify independent predictors of the outcomes.
Overall, 213 patients underwent Z0BTEVAR, including 111 patients treated for C-AD and 102 patients treated for N-AD. The median age was 72 years old. Overall composite outcome was 10.3%, higher for N-AD patients compared to C-AD patients (15.7% vs. 5.4%; p=0.01). Similarly, N-AD patients had more post-operative strokes (17.7% vs. 4.5%; p |
| doi_str_mv | 10.1016/j.jvs.2024.11.039 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_proquest_miscellaneous_3147130175</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0741521424021967</els_id><sourcerecordid>3147130175</sourcerecordid><originalsourceid>FETCH-LOGICAL-e1086-d1298dbddde34a7f8b392b39daaf99cb14cca112e435177c081ca0ef9e07f1623</originalsourceid><addsrcrecordid>eNo1kTFv2zAQhYmiQe0m-QFdCo5dpPBESRTRKXXS1kCABEGyZCHO5KmmIYkuKRnwv68Mp8PhLR8eHu5j7AuIHATUN7t8d0h5IYoyB8iF1B_YEoRWWd0I_ZEthSohqwooF-xzSjshAKpGfWILqWtdQlUvGa77PdqRh5bfRrvldz4RJuJPOG5DF_4ceRj44zTa0FM6UW9hIC74j4iD3ZLjL9sQ0XrL7wcXDpjs1GE8dz3THn28Yhctdomu3_OSvf68f1n9zh4ef61Xtw8ZgWjqzEGhG7dxzpEsUbXNRupiPofYam03UFqLAAWVsgKlrGjAoqBWk1At1IW8ZN_OvfsY_k6URtP7ZKnrcKAwJSOhVCAFqGpGv76j06YnZ_bR9xiP5v9bZuD7GaB58MFTNMl6Giw5H8mOxgVvQJiTBLMzswRzkmAAzCxB_gOe5Hjy</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3147130175</pqid></control><display><type>article</type><title>Impact of Arch Disease Pathology on Outcomes of Zone 0 Branched Thoracic Endovascular Arch Repair</title><source>Access via ScienceDirect (Elsevier)</source><creator>Guo, Ming Hao ; Kölbel, Tilo ; Le Houerou, Thomas ; Mesnard, Thomas ; Sobocinski, Jonathan ; Nana, Petroula ; Haulon, Stéphan</creator><creatorcontrib>Guo, Ming Hao ; Kölbel, Tilo ; Le Houerou, Thomas ; Mesnard, Thomas ; Sobocinski, Jonathan ; Nana, Petroula ; Haulon, Stéphan</creatorcontrib><description>Zone 0 branched thoracic endovascular arch repair (Z0BTEVAR) has emerged as an alternative to open repair for high-risk patients with aortic arch pathology. However, it is unclear how disease characteristics in this population impacts clinical outcomes. The study aimed to compare Z0BTEVAR according to arch disease pathology and to identify potential predictors of post-operative outcomes.
From 2011 to 2023, patients who underwent Z0BTEVAR for chronic aortic dissection (C-AD) or for non-aortic dissection (N-AD) etiology at 3 European centers were included. The primary outcome was a composite of in-hospital mortality and disabling stroke. Multivariable logistic analyses were conducted to identify independent predictors of the outcomes.
Overall, 213 patients underwent Z0BTEVAR, including 111 patients treated for C-AD and 102 patients treated for N-AD. The median age was 72 years old. Overall composite outcome was 10.3%, higher for N-AD patients compared to C-AD patients (15.7% vs. 5.4%; p=0.01). Similarly, N-AD patients had more post-operative strokes (17.7% vs. 4.5%; p<0.01). On multivariable analysis, previous type A aortic dissection was protective for the composite outcome (OR 0.2; C.I. 0.1–0.6), while degenerative aneurysm with zone 0 or 1 involvement was predictive of post-operative stroke (OR 3.7; CI 1.2–11.8). At 4 years, survival for the N-AD group was 71.8±6.6%, and for the C-AD group was 71.5±6.5% (p=0.81).
Z0BTEVAR could be performed with satisfactory short- and mid-term outcomes for high-risk patients, particularly those with previous dissection. Patient selection is important, and continued effort should be placed on minimizing post-operative stroke.
•Type of Research: Multicenter retrospective cohort study•Key Findings: Zone 0 branched thoracic endovascular arch repair in 213 patients showed the procedure could be performed in high-risk patients with satisfactory outcomes, particularly for those with previous dissection. Previous type A dissection was protective of the mortality and disabling stroke, while degenerative aneurysm with zone 0 & 1 involvement and penetrating ulcer were predictive of post-operative stroke.•Take Home Message: Patient selection is important to identify those at higher risk of complications, and continued effort should be placed on minimizing post-operative stroke.</description><identifier>ISSN: 0741-5214</identifier><identifier>ISSN: 1097-6809</identifier><identifier>EISSN: 1097-6809</identifier><identifier>DOI: 10.1016/j.jvs.2024.11.039</identifier><identifier>PMID: 39694156</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aortic arch aneurysm ; dissection ; endovascular</subject><ispartof>Journal of vascular surgery, 2024-12</ispartof><rights>2024</rights><rights>Copyright © 2024. Published by Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><orcidid>0000-0003-4560-680X ; 0000-0002-1995-4985 ; 0000-0001-9060-8519</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39694156$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Guo, Ming Hao</creatorcontrib><creatorcontrib>Kölbel, Tilo</creatorcontrib><creatorcontrib>Le Houerou, Thomas</creatorcontrib><creatorcontrib>Mesnard, Thomas</creatorcontrib><creatorcontrib>Sobocinski, Jonathan</creatorcontrib><creatorcontrib>Nana, Petroula</creatorcontrib><creatorcontrib>Haulon, Stéphan</creatorcontrib><title>Impact of Arch Disease Pathology on Outcomes of Zone 0 Branched Thoracic Endovascular Arch Repair</title><title>Journal of vascular surgery</title><addtitle>J Vasc Surg</addtitle><description>Zone 0 branched thoracic endovascular arch repair (Z0BTEVAR) has emerged as an alternative to open repair for high-risk patients with aortic arch pathology. However, it is unclear how disease characteristics in this population impacts clinical outcomes. The study aimed to compare Z0BTEVAR according to arch disease pathology and to identify potential predictors of post-operative outcomes.
From 2011 to 2023, patients who underwent Z0BTEVAR for chronic aortic dissection (C-AD) or for non-aortic dissection (N-AD) etiology at 3 European centers were included. The primary outcome was a composite of in-hospital mortality and disabling stroke. Multivariable logistic analyses were conducted to identify independent predictors of the outcomes.
Overall, 213 patients underwent Z0BTEVAR, including 111 patients treated for C-AD and 102 patients treated for N-AD. The median age was 72 years old. Overall composite outcome was 10.3%, higher for N-AD patients compared to C-AD patients (15.7% vs. 5.4%; p=0.01). Similarly, N-AD patients had more post-operative strokes (17.7% vs. 4.5%; p<0.01). On multivariable analysis, previous type A aortic dissection was protective for the composite outcome (OR 0.2; C.I. 0.1–0.6), while degenerative aneurysm with zone 0 or 1 involvement was predictive of post-operative stroke (OR 3.7; CI 1.2–11.8). At 4 years, survival for the N-AD group was 71.8±6.6%, and for the C-AD group was 71.5±6.5% (p=0.81).
Z0BTEVAR could be performed with satisfactory short- and mid-term outcomes for high-risk patients, particularly those with previous dissection. Patient selection is important, and continued effort should be placed on minimizing post-operative stroke.
•Type of Research: Multicenter retrospective cohort study•Key Findings: Zone 0 branched thoracic endovascular arch repair in 213 patients showed the procedure could be performed in high-risk patients with satisfactory outcomes, particularly for those with previous dissection. Previous type A dissection was protective of the mortality and disabling stroke, while degenerative aneurysm with zone 0 & 1 involvement and penetrating ulcer were predictive of post-operative stroke.•Take Home Message: Patient selection is important to identify those at higher risk of complications, and continued effort should be placed on minimizing post-operative stroke.</description><subject>Aortic arch aneurysm</subject><subject>dissection</subject><subject>endovascular</subject><issn>0741-5214</issn><issn>1097-6809</issn><issn>1097-6809</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><recordid>eNo1kTFv2zAQhYmiQe0m-QFdCo5dpPBESRTRKXXS1kCABEGyZCHO5KmmIYkuKRnwv68Mp8PhLR8eHu5j7AuIHATUN7t8d0h5IYoyB8iF1B_YEoRWWd0I_ZEthSohqwooF-xzSjshAKpGfWILqWtdQlUvGa77PdqRh5bfRrvldz4RJuJPOG5DF_4ceRj44zTa0FM6UW9hIC74j4iD3ZLjL9sQ0XrL7wcXDpjs1GE8dz3THn28Yhctdomu3_OSvf68f1n9zh4ef61Xtw8ZgWjqzEGhG7dxzpEsUbXNRupiPofYam03UFqLAAWVsgKlrGjAoqBWk1At1IW8ZN_OvfsY_k6URtP7ZKnrcKAwJSOhVCAFqGpGv76j06YnZ_bR9xiP5v9bZuD7GaB58MFTNMl6Giw5H8mOxgVvQJiTBLMzswRzkmAAzCxB_gOe5Hjy</recordid><startdate>20241216</startdate><enddate>20241216</enddate><creator>Guo, Ming Hao</creator><creator>Kölbel, Tilo</creator><creator>Le Houerou, Thomas</creator><creator>Mesnard, Thomas</creator><creator>Sobocinski, Jonathan</creator><creator>Nana, Petroula</creator><creator>Haulon, Stéphan</creator><general>Elsevier Inc</general><scope>NPM</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-4560-680X</orcidid><orcidid>https://orcid.org/0000-0002-1995-4985</orcidid><orcidid>https://orcid.org/0000-0001-9060-8519</orcidid></search><sort><creationdate>20241216</creationdate><title>Impact of Arch Disease Pathology on Outcomes of Zone 0 Branched Thoracic Endovascular Arch Repair</title><author>Guo, Ming Hao ; Kölbel, Tilo ; Le Houerou, Thomas ; Mesnard, Thomas ; Sobocinski, Jonathan ; Nana, Petroula ; Haulon, Stéphan</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-e1086-d1298dbddde34a7f8b392b39daaf99cb14cca112e435177c081ca0ef9e07f1623</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Aortic arch aneurysm</topic><topic>dissection</topic><topic>endovascular</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Guo, Ming Hao</creatorcontrib><creatorcontrib>Kölbel, Tilo</creatorcontrib><creatorcontrib>Le Houerou, Thomas</creatorcontrib><creatorcontrib>Mesnard, Thomas</creatorcontrib><creatorcontrib>Sobocinski, Jonathan</creatorcontrib><creatorcontrib>Nana, Petroula</creatorcontrib><creatorcontrib>Haulon, Stéphan</creatorcontrib><collection>PubMed</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of vascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Guo, Ming Hao</au><au>Kölbel, Tilo</au><au>Le Houerou, Thomas</au><au>Mesnard, Thomas</au><au>Sobocinski, Jonathan</au><au>Nana, Petroula</au><au>Haulon, Stéphan</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of Arch Disease Pathology on Outcomes of Zone 0 Branched Thoracic Endovascular Arch Repair</atitle><jtitle>Journal of vascular surgery</jtitle><addtitle>J Vasc Surg</addtitle><date>2024-12-16</date><risdate>2024</risdate><issn>0741-5214</issn><issn>1097-6809</issn><eissn>1097-6809</eissn><abstract>Zone 0 branched thoracic endovascular arch repair (Z0BTEVAR) has emerged as an alternative to open repair for high-risk patients with aortic arch pathology. However, it is unclear how disease characteristics in this population impacts clinical outcomes. The study aimed to compare Z0BTEVAR according to arch disease pathology and to identify potential predictors of post-operative outcomes.
From 2011 to 2023, patients who underwent Z0BTEVAR for chronic aortic dissection (C-AD) or for non-aortic dissection (N-AD) etiology at 3 European centers were included. The primary outcome was a composite of in-hospital mortality and disabling stroke. Multivariable logistic analyses were conducted to identify independent predictors of the outcomes.
Overall, 213 patients underwent Z0BTEVAR, including 111 patients treated for C-AD and 102 patients treated for N-AD. The median age was 72 years old. Overall composite outcome was 10.3%, higher for N-AD patients compared to C-AD patients (15.7% vs. 5.4%; p=0.01). Similarly, N-AD patients had more post-operative strokes (17.7% vs. 4.5%; p<0.01). On multivariable analysis, previous type A aortic dissection was protective for the composite outcome (OR 0.2; C.I. 0.1–0.6), while degenerative aneurysm with zone 0 or 1 involvement was predictive of post-operative stroke (OR 3.7; CI 1.2–11.8). At 4 years, survival for the N-AD group was 71.8±6.6%, and for the C-AD group was 71.5±6.5% (p=0.81).
Z0BTEVAR could be performed with satisfactory short- and mid-term outcomes for high-risk patients, particularly those with previous dissection. Patient selection is important, and continued effort should be placed on minimizing post-operative stroke.
•Type of Research: Multicenter retrospective cohort study•Key Findings: Zone 0 branched thoracic endovascular arch repair in 213 patients showed the procedure could be performed in high-risk patients with satisfactory outcomes, particularly for those with previous dissection. Previous type A dissection was protective of the mortality and disabling stroke, while degenerative aneurysm with zone 0 & 1 involvement and penetrating ulcer were predictive of post-operative stroke.•Take Home Message: Patient selection is important to identify those at higher risk of complications, and continued effort should be placed on minimizing post-operative stroke.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>39694156</pmid><doi>10.1016/j.jvs.2024.11.039</doi><orcidid>https://orcid.org/0000-0003-4560-680X</orcidid><orcidid>https://orcid.org/0000-0002-1995-4985</orcidid><orcidid>https://orcid.org/0000-0001-9060-8519</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0741-5214 |
| ispartof | Journal of vascular surgery, 2024-12 |
| issn | 0741-5214 1097-6809 1097-6809 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_3147130175 |
| source | Access via ScienceDirect (Elsevier) |
| subjects | Aortic arch aneurysm dissection endovascular |
| title | Impact of Arch Disease Pathology on Outcomes of Zone 0 Branched Thoracic Endovascular Arch Repair |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-01T17%3A31%3A41IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Impact%20of%20Arch%20Disease%20Pathology%20on%20Outcomes%20of%20Zone%200%20Branched%20Thoracic%20Endovascular%20Arch%20Repair&rft.jtitle=Journal%20of%20vascular%20surgery&rft.au=Guo,%20Ming%20Hao&rft.date=2024-12-16&rft.issn=0741-5214&rft.eissn=1097-6809&rft_id=info:doi/10.1016/j.jvs.2024.11.039&rft_dat=%3Cproquest_pubme%3E3147130175%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=3147130175&rft_id=info:pmid/39694156&rft_els_id=S0741521424021967&rfr_iscdi=true |