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May 12, 2020

Medtronic’s Valiant Captivia TEVAR Device to Treat Acute Complicated TBAD Evaluated at 5-Year Follow-Up

May 12, 2020—Online in Journal of Thoracic and Cardiovascular Surgery (JTCVS), Joseph E. Bavaria, MD, et al reported the 5-year outcomes of thoracic endovascular aortic repair (TEVAR) of complicated acute type B aortic dissection (TBAD) in the DISSECTION trial.

In the prospective, nonrandomized DISSECTION trial, 50 patients were treated with the Valiant Captivia thoracic stent graft (Medtronic) for acute complicated TBAD. All-cause mortality, secondary procedures, and serious adverse events were assessed. A core lab evaluated images for aortic remodeling.

In JTCVS, the investigators reported that compliance for both clinical and imaging follow-up was 78% (18/23) for the available patients at 5 years. Notable baseline characteristics were malperfusion in 86% (43/50), ruptures in 20% (10/50), and DeBakey class IIIb dissections in 94% (46/49).

Key 5-year findings included:

  • Freedom from dissection-related mortality, secondary procedures related to the dissection, and endoleaks were 83%, 86%, and 85%, respectively.
  • Completely thrombosed false lumen in the stented segment of the aorta was seen in 89% (16/18) of patients.
  • True lumen diameter over the length of the stent graft was stable or increased for 94% (16/17) of patients.
  • False lumen diameter was stable or decreased in 77% (13/17) of patients.

Patients in the DISSECTION trial experienced positive and sustained measures of aortic remodeling with survival outcomes, need for secondary procedures, and adverse event rates consistent with previous TEVAR studies. Although limitations exist with the follow-up compliance, the Valiant Captivia thoracic stent graft system was effective in the long-term management of acute complicated TBAD in this challenging patient population, concluded the investigators in JTCVS.

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