Outcomes of post-implantation syndrome after endovascular repair for Stanford type B aortic dissection.

OBJECTIVE: To investigate the correlation between post-implantation syndrome (PIS) and long-term prognosis in patients with Stanford type B aortic dissection (TBAD) undergoing thoracic endovascular aortic repair (TEVAR).

METHODS: This retrospective study included 547 consecutive patients diagnosed with TBAD who underwent TEVAR at our institution between January 2014 and December 2019. Patients were categorized into two groups: the PIS group (patients with post-TEVAR PIS) and the non-PIS group (patients without post-TEVAR PIS). In-hospital and follow-up data were analyzed.

RESULTS: The incidence of PIS was 28.9% (158/547 patients). No baseline differences were observed between the PIS (n=158) and the non-PIS (n=389) groups. The proportion of emergency surgery in the PIS group was higher than that in the non-PIS group (44.9% vs. 26.0%, p<0.001), the operation time was longer [65.0 (56.0, 75.0) vs. 56.0 (45.0, 66.0) min, p<0.001], the volume of contrast medium used [65.0 (56.0, 75.0) vs. 56.0 (45.0, 66.0) mL, p<0.001], and the average number of trunk stents (1.85±0.4 vs. 1.34±0.5 piece, p<0.001) and branch stents (0.7±0.7 vs. 0.2±0.5 piece, p<0.001) used were more in the PIS group than in the non-PIS group. The incidence of supra-aortic branch procedures was higher in the PIS group than in the non-PIS group. There was no significant difference in device-related complications (DRC) or 30-day mortality between the two groups (2.5% vs. 4.4%, p=0.442 and 1.3% vs. 1.3%, p=0.688, respectively). Univariate and multivariable logistic regression analysis showed that emergency surgery, number of trunk stents >1, operation time >58.5 min, and contrast medium volume >75 mL were risk factors for PIS, and the odds ratios of emergency operation, number of trunk stents >1 piece, operation time >58.5 min, and contrast medium volume >75 mL were 2.526 (1.530-4.173), 4.651 (2.838-7.624), 3.577 (2.201-5.815), and 7.356 (4.111-13.160), respectively. Follow-up was completed in 98.5% (532/540) of the patients, with a median follow-up of 67 months (50, 86). There was no significant difference in survival between the PIS and non-PIS groups (12.4% vs. 10.3%, p=0.476) during follow-up. The incidences of DRC (7.8% vs. 11.6%, p=0.200) and aortic false lumen thrombosis (FLT) (75.8% vs. 79.2%, p=0.399) were comparable between the PIS and non-PIS groups. Univariate logistic regression analysis showed that PIS had no effect on long-term follow-up mortality, DRC, entry flow, or aortic FLT rate.

CONCLUSIONS: PIS is relatively common after TEVAR and emergency surgery; number of trunk stents >1, operation time >58.5 min, and contrast medium volume >75 mL are of high predictive value for the assessment of PIS after TEVAR. However, PIS had little effect on early and late postoperative mortality or DRC.