Anatomic feasibility of next-generation stent grafts for the management of type a aortic dissection in Japanese patients

Background: The aims of the present study were to analyze the anatomical characteristics of type A aortic dissections (TAAD) in Japanese patients and evaluate the feasibility of 3 next-generation stent grafts dedicated to ascending/arch aortic lesions. Methods and Results: We analyzed 172 consecutive patients surgically treated for TAAD at 2 institutions between 2007 and 2015. Computed tomography (CT) images and operative records were used to identify the location of entry tear (ET). The anatomical feasibility of the Zenith Ascend, Zenith A-branch, and TAG Thoracic Branch Endoprosthesis (TBE) was evaluated using the manufacturers’ instructions for use (IFU). In total, 131 patients were included in the final analysis. Dissection was present at the sinotubular junction (STJ) in 107 patients (81.7%), and the mean diameter of the STJ was 39.4±6.0 mm. The ET was at the STJ (n=33), ascending aorta (n=47), aortic arch (n=30), and descending aorta (n=21). The mean lengths from STJ to innominate artery and STJ to ET were 79.5±11.4 mm and 57.8±52.1 mm, respectively. When we applied the IFU to each anatomical measurement, we identified 0 patients as candidates for Zenith Ascend, 9 (6.9%) for Zenith A-branch, and 60 (45.8%) for TAG TBE. Conclusions: Endovascular treatment for TAAD was not feasible for most of this study population, with risk of stent graft-induced new entry in 81.7% of patients, despite the use of next-generation stent grafts.