ABSTRACT
Objective To evaluate the effect of the pre-operative health status on outcome of thoracic endovascular aortic repair (TEVAR) in patientswith type Baortic dissection (BAD). Methods The clinical data of 328 BAD patients, who underwent TEVAR between September 1998 and December 2011, were retrospectively analyzed. The patients were divided into ASA3 group and S 3 group according to American Society of Anesthesiologists (ASA) classificationbefore TEVAR. Univariable and multivariate Cox proportional hazard regression model analysis were used to evaluate the difference in outcomes of patients in the two groups. Results There was no significant difference in the complication rates between the two groups during the peri-operation period. During follow-up, the all-cause mortality rates and risks of transferring to open operationwere similar between the two groups; however, patients in group had a significantly higher re-TEVAR rate than those in 3 group (Hazard ratio=2. 50, 95% CI: 1. 05-5. 91, P = 0. 037). Conclusion TEVAR is a safe alternative for TbAD patients. Poor pre-operative health status has negative effect on the postoperative outcome of TEVAR. Patients with a good health status are suitable for TEVAR.
ABSTRACT
<p><b>BACKGROUND</b>Most of endovascular stent-graft modifications to preserve side branch must be customized according to extensive pre-operative assessment, which may not be possible in many hospitals and emergency settings. The study was to develop a novel stent-grafts system that would allow in situ "fenestration", with less reliance on preoperative imaging.</p><p><b>METHODS</b>The magnitude of pressure difference (PD) between left subclavian artery (LSA) and aortic arch were measured in 12 experimental pigs. Changes of PD before and after LSA was covered were analyzed respectively. The novel stent graft was made by multi-dimensional and multiple textiles forming technology. According to the PD measurement in pigs, we evaluated the feasibility of the stent-graft in a mock circulation system.</p><p><b>RESULTS</b>In pigs, the blood pressure of aortic arch was significantly higher than that of LSA after it was covered (P < 0.001) and PD was (42.78 ± 5.17) mmHg. After target vessel was covered and when PD between the LSA and aorta reached the magnitude measured in pigs, contrast media oozed from the cranny of graft to the LSA, which was generated by sliding and deformation of yarns of novel stent-graft.</p><p><b>CONCLUSIONS</b>The study proposes the design of pressure difference-induced perforation aortic stent-grafts system and verifies that the PD between LSA and aortic arch is high enough to allow in situ "fenestration" by stent graft made by multi-dimensional and multiple textiles forming technology.</p>