• Jacob Budtz-Lilly, Per Vikholm, Anders Wanhainen, Rafael Astudillo, Stefan Thelin, and Kevin Mani.
• Section of Vascular Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden; Department of Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark. Electronic address: jacobudt@rm.dk.
• J. Thorac. Cardiovasc. Surg. 2021 Sep 1; 162 (3): 770-777.

ObjectiveThe objective was to report on the technical eligibility of patients previously treated for Stanford type A aorta dissection for endovascular aortic arch repair based on contemporary anatomic criteria for an arch inner-branched stent graft.MethodsAll patients treated for type A aorta dissection from 2004 to 2015 at a single aortic center were identified. Extent of repair and use of circulatory arrest were reported. Survival and reoperation were assessed using Kaplan-Meier and competing risk models. Anatomic assessment was performed using 3-dimensional computed tomography imaging software. Primary outcome was survival of 1 year or more and fulfillment of the arch inner-branched stent graft anatomic criteria.ResultsA total of 198 patients were included (158 DeBakey I, 32 DeBakey II, and 8 intramural hematoma). Mortality was 30 days (16.2%), 1 year (16.3%), and 10 years (45.0%). A total of 129 patients had imaging beyond 1 year (mean, 47.8 months), and 89 patients (69.0%) were eligible for arch inner-branched stent grafting. During follow-up, 19 patients (14.7%) met the threshold criteria for aortic arch treatment, of whom 14 (73.7%) would be considered eligible for arch inner-branched stent graft. Patients who underwent type A aorta dissection repair with circulatory arrest and no distal clamp were more often eligible for endovascular repair (88.8%) than those operated with a distal clamp (72.5%; P = .021). Among patients who did not meet the arch inner-branched stent graft anatomic criteria, the primary reasons were mechanical valve (40%) and insufficient proximal seal (30%).ConclusionsMore than two-thirds of patients post-type A aorta dissection repair are technically eligible for endovascular arch inner-branched stent graft repair. The development of devices that can accommodate a mechanical aortic valve and a greater awareness of sufficient graft length would significantly increase availability.Copyright © 2020 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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