Impact of Prior Thoracic Endovascular Aortic Repair on Outcomes After Open Thoracoabdominal Aortic Replacement for Type B Aortic Dissection.

BACKGROUND: Thoracic endovascular aortic repair (TEVAR) is a primary treatment for complicated type B aortic dissection (TBAD). However, some patients eventually require open thoracoabdominal aortic replacement (TAAR). Comparative outcomes data for TAAR with vs without prior TEVAR remain limited. METHODS: In this single-centre retrospective study of 198 patients undergoing TAAR for TBAD, we compared outcomes between those with (n = 60) vs without (n = 138) prior TEVAR. The primary endpoint was a composite of in-hospital death, spinal cord injury, or stroke. RESULTS: The composite endpoint was significantly higher in the prior-TEVAR group (25.0% vs 7.3%, P < 0.001). In-hospital mortality was similar (11.7% vs 5.1%, P = 0.173), whereas spinal cord injury (10.0% vs 2.2%, P = 0.040) and cerebral hemorrhage (6.7% vs 0%, P = 0.012) were higher with prior TEVAR. Prior TEVAR independently predicted this composite outcome (odds ratio 3.72, P = 0.006). Patients with prior TEVAR had higher rates of reintubation (8.3% vs 1.5%, P = 0.046), and dialysis-requiring acute kidney injury also trended higher in this group (23.3% vs 12.3%, P = 0.050).Prior TEVAR was an independent predictor for late reintervention (hazard ratio 2.74, P = 0.030). CONCLUSIONS: Prior TEVAR was associated with increased perioperative morbidity and late reintervention risk in patients undergoing TAAR for TBAD. This association underscores the need for enhanced perioperative management and long-term follow-up in this high-risk cohort.