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

The thoracic branch endoprosthesis (TBE®, WL Gore, Flagstaff AZ) offers an off-the-shelf single option for thoracic endovascular aortic repair (TEVAR) of aortic arch pathology with sealing in zones 0-2. 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- March 2024). Patients treated for complicated aortic dissection, symptomatic aneurysm/pseudoaneurysm (PSA), or blunt traumatic aortic injury (BTAI) by urgent/emergent repair were included. End-points were 30-day mortality, major adverse events (MAEs: 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 60±15 years-old) underwent repair for acute indications including 70 (65%) dissections, 21 (20%) symptomatic aneurysms/PSA and 16 (15%) BTAIs. Eight (8%) patients had repair immediately after open ascending repair of a Type A dissection. Proximal sealing was in zone 2 in 91 patients (89%) and zone 0-1 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 (2%) patients died and 19 (18%) developed MAEs, including stroke in 6 (6%) and paraplegia in 6 (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 (94%) patients had follow-up imaging. Type IA or III endoleak occurred in seven patients (7%), retrograde branch occlusion in one (1%), and eleven (10%) required re-intervention. 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. •Type of Research: Multicenter retrospective cohort study.•Key Findings: In 107 patients with acutely symptomatic aortic pathology undergoing urgent or emergent TEVAR with the Gore TBE device, we achieved 99% technical success, with an 18% rate of major adverse events within 30 days.•Take home Message: Urgent/emergent TEVAR with the Gore TBE device in acute pathology offers low mortality, stroke, and paraplegia risk.