Outcomes of Endovascular Therapy for Stanford Type B Aortic Dissection in Patients with Sleep Apnea Syndrome.

ABSTRACT

OBJECTIVE: This study aimed to determine the influences of varying severity of sleep apnea syndrome (SAS) on the outcomes after thoracic endovascular aorta repair (TEVAR) in patients with Stanford type B aortic dissection (TBAD). METHODS: This observational study focused on individuals with TBAD plus SAS who received TEVAR between January 2018 and December 2022. Patients were divided into groups according to the results of the portable sleep-breathing monitoring systems (PSMS) mild SAS (MSAS) and moderate-to-severe SAS (MSSAS). Clinical profiles were collected and analyzed. RESULTS: A total of 121 cases with TBAD plus SAS who underwent TEVAR were enrolled in this study. Two groups were formed by stratifying these cases MSAS (74 cases) and MSSAS (47 cases). The MSSAS cases were found to be older relative to MSAS cases (51.7 ± 8.3 vs. 57.1 ± 12.8 years, p = 0.012) and had a higher body mass index (BMI; 25.7 ± 2.3 vs. 27.0 ± 2.3 kg/m2, p = 0.038). The investigation did not find any appreciable differences between the MSAS and MSSAS groups in terms of complications (endoleak p = 0.403, SINE p = 1.000, stent displacement p = 1.000). However, the MSSAS group exhibited a significantly higher overall mortality rate compared to MSAS group (log-rank p = 0.027). The tendency continued when examining cases with Marfan syndrome (MFS) combined with MSSAS, where the overall mortality rate was significantly greater compared to MFS cases with MSAS (log-rank p = 0.037). The absence of a significant difference was noteworthy in the freedom from reintervention between the MSAS and MSSAS groups (log-rank p = 0.278). The overall mortality rate was significantly higher in MSSAS group even after adjusting for varying potential confounders in the multivariate cox regression analysis (HR 95%CI 1.875 [1.238-2.586], p = 0.012). A markedly higher rate of distal stent dilation in the MSSAS group was also observed compared to the MSAS group (2.5 [2, 3] vs. 4 [2, 5.5] mm/year, p = 0.029). CONCLUSIONS: MSSAS is associated with a significantly higher risk of overall mortality and dilation rate of the distal stent after TEVAR for TBAD patients. Hence, aggressive efforts to reverse the severity of SAS in time in these individuals appear necessary.