About Timing of TEVAR in Dissection

Congratulations to Ouchi and colleagues 1 Ouchi T. Kato N. Kato H. et al. Relevance of aortic dissection chronicity to the development of stent graft–induced new entry. Ann Thorac Surg. 2020; 110: 1983-1989 Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar for their effort. The authors stated that residual aortic dissection after open surgery was seen more frequently in the late group. We think that the existence of residual aortic dissection after open surgery is not associated with the formation of reentry. The factors affecting stent-induced new entry occurrence are as follows: graft diameter used in open surgery, diameter of thoracic endovascular aortic repair stent graft (excessive oversizing), reentry site, and diameters of both true and false lumens. Most of the primary intimal tears in type 1 aortic dissections are seen in aortic wall next to the noncoronary cusp of the aortic valve. This demonstrates the significance of jet flow on intimal injury. After placement of a thoracic endovascular aortic repair stent graft, particularly in cases in which aortic remodeling does not allow full expansion of the stent, the blood flow becomes turbulent, thus damaging the intima. Relevance of Aortic Dissection Chronicity to the Development of Stent Graft–induced New EntryThe Annals of Thoracic SurgeryVol. 110Issue 6PreviewThe relevance of aortic dissection chronicity to the development of stent graft–induced new entry (SINE) is unknown. Full-Text PDF Relevance of Residual Dissection After Thoracotomy to Development of Stent Graft–induced New EntryThe Annals of Thoracic SurgeryVol. 115Issue 3PreviewWe thank Dr Yurekli and colleagues1 for raising an important question about our article in The Annals of Thoracic Surgery.2 To answer this question, we conducted an additional analysis about the relevance of residual aortic dissection (AD) after open surgical repair to the development of stent graft–induced new entry (SINE). In our cohort, 29 patients (42%) had residual AD after open surgery.2 No statistically significant difference in the incidence of SINE was found between the patients with residual AD and the patients with de novo type B AD (21% [6/29] vs 30% [12/40]; P = .28). Full-Text PDF