1. Osaka University Graduate School of Medicine Division of Cardiovascular Surgery Strategy of TEVAR for acute aortic dissection Osaka University Graduate school of Medicine, Division of Cardiovascular surgery Takuya Yoshida, Toru Kuratani, Kazuo Shimamura, Yukitoshi Shirakawa, Mugiho Takeuchi, Keiwa Kin, Yoshiki Sawa

2. Osaka University Graduate School of Medicine Division of Cardiovascular Surgery Strategy of TEVAR for acute aortic dissection ・ Minimal coverage of each thoracic intimal tear (short stent graft) ・ Strict sizing (proximal 110-115%, distal -110%)

3. Osaka University Graduate School of Medicine Division of Cardiovascular Surgery To assess the outcome of TEVAR for acute aortic dissection with minimal intimal tear closure. Objective

4. Osaka University Graduate School of Medicine Division of Cardiovascular Surgery Patient demographics Primary TEVAR for aortic dissection (1998 － 2009) in acute phase (<2week) 36 cases Age 61.5±10.3 Gender (M/F) 21 / 10 Type of dissection Type A 7 Type B 29 complicated Type B 17 uncomplicated Type B 12

5. Osaka University Graduate School of Medicine Division of Cardiovascular Surgery Device selection Homemade 29 Homemade + TAG 1 Homemade + Excluder cuff 2 TAG 2 Excluder cuff 2 Average length of the stent-graft 10.3 cm

6. Osaka University Graduate School of Medicine Division of Cardiovascular Surgery Representive case Pre operation Post operation Gore Aortic Extender Cuff 3.3cm

7. Osaka University Graduate School of Medicine Division of Cardiovascular Surgery Early Results Operative outcome Procedure success 36/36 (100%) Procedure success 36/36 (100%) Mortality Mortality2 /36(5.6%) (arrhythmia, intestinal necrosis)Morbidity Stroke0 Spinal cord ischemia0 Retrograde type A dissection0 intimal tear creation0 Iliac rupture0 Endoleak at 1 st postoperative CT 1 /36 (2.8%)

8. Osaka University Graduate School of Medicine Division of Cardiovascular Surgery Diameter of DTA 40 30 PrePost6m1y3y5y7y 35 Duration from TEAVR Maximum diameter (mm) P=.0091 TEVAR Thoracic false lumen thrombosis 32/36 (88.9%)

9. Osaka University Graduate School of Medicine Division of Cardiovascular Surgery follow up: average 30.1±32.0 month, max 129month Freedom from aortic death Stanford A: 100% Uncomplicated type B: 100% Complicated type B: 88.2% month Freedom from aortic death (%) Over all: 94.4%

10. Osaka University Graduate School of Medicine Division of Cardiovascular Surgery eventPOMprocedure proximal ULP 3TEVAR Ascending Ao ULP 7TAR eventPOMprocedure proximal ULP 5TEVAR distal endoleak 6TEVAR proximal + distal ULP 14TAR+TEVAR iliac aneurysm 19 graft replacement Stanford B Stanford A Long term results: Aortic event

11. Osaka University Graduate School of Medicine Division of Cardiovascular Surgery Type A: 50%/5year, 50%/10year Overall: 69.9%/5year, 69.9%/10year Type B: 71.8%/5year, 71.8%/10year Freedom from aortic event (%) month Freedom from aortic event

12. Osaka University Graduate School of Medicine Division of Cardiovascular Surgery Conclusions ・ TEVAR with minimal coverage of each thoracic intimal tear provided good early phase protection. ・ Although further investigation is necessary regarding late aortic events, this strategy may achieve the goal of false lumen thrombosis, without incurring the risks of covering the whole aorta.