Multi-center experience with an off-the-shelf single retrograde thoracic branch endoprosthesis for acute aortic pathology

The thoracic branch endoprosthesis (TBE) (W.L. Gore) offers an off-the-shelf single option for thoracic endovascular aortic repair (TEVAR) of aortic arch pathology with sealing in zones 0 to 2. This study reports the early outcomes of TBE-TEVAR for acute indications. Clinical data, imaging, and outcomes of patients treated with TBE-TEVAR at seven institutions were retrospectively reviewed (March 2017 to March 2024). Patients treated for complicated aortic dissection, symptomatic aneurysm/pseudoaneurysm, or blunt traumatic aortic injury by urgent/emergent repair were included. End points were 30-day mortality, major adverse events (mortality, myocardial infarction, prolonged intubation, stroke, paraplegia, dialysis, or bowel ischemia), and technical success. Of 356 patients treated by TBE-TEVAR, 107 (69.0% male; mean age, 60 ± 15 years) underwent repair for acute indications including 70 dissections (65%), 21 symptomatic aneurysms/pseudoaneurysms (20%), and 16 blunt traumatic aortic injuries (15%). Eight patients (8%) had repair immediately after open ascending repair of a type A dissection. Proximal sealing was in zone 2 in 91 patients (89%) and zone 0 to 1 in 11 patients (11%) who required cervical debranching. Technical success was achieved in all (99%) except one patient with acute dissection and aneurysmal degeneration requiring staged repair. At 30 days, two patients (2%) died, and 19 patients (18%) developed major adverse events, including stroke in six patients (6%) and paraplegia in six patients (6%). Five patients (5%; all Zone 2) had retrograde dissections, all treated for acute or subacute dissection, with no mortality. Mean follow-up was 55 ± 171 days, and 96 patients (94%) had follow-up imaging. Type IA or III endoleak occurred in seven patients (7%), retrograde branch occlusion in one (1%), and eleven (10%) required reintervention. Cumulative aortic-related mortality was three (3%) from aortic rupture. Urgent/emergent TEVAR with the Gore TBE device in acute pathology offers low mortality, stroke, and paraplegia risk. Longer follow-up is needed to assess effectiveness of the repair.