Aortic remodeling predicts long-term survival and freedom from reintervention after thoracic endovascular aortic repair for chronic type B aortic dissection including residual type A dissection

<h2>Abstract</h2><h3>Background</h3> The optimal timing for thoracic endovascular aortic repair in chronic type B aortic dissection is controversial, largely because the long-term impact of aortic remodeling on clinical outcomes remains unclear. This study investigates the prognostic value of aortic remodeling and identifies its key determinants. <h3>Methods</h3> In a retrospective analysis of 95 patients treated with thoracic endovascular aortic repair for chronic type B aortic dissection, we defined aortic remodeling as a ≥5 mm decrease in aortic diameter. We then assessed its association with 5-year survival and freedom from reintervention and identified preoperative predictors for its occurrence. <h3>Results</h3> Achieving aortic remodeling was associated with a dramatic improvement in long-term outcomes. Patients in the remodeling group (n=57) had the estimated 5-year survival rate of 98.0%, compared to 80.0% in the non-remodeling group (n=38; P=.003). Freedom from reintervention was also substantially higher at 91.3% in the remodeling group versus 50.0% in the non-remodeling group (P<.0001). This favorable remodeling was most likely to occur in patients treated sooner after the initial dissection (median 12 months vs 78 months, P<.001) and in those with a smaller preoperative aortic diameter at the diaphragmatic level (median 34 mm vs 42 mm, P<.001). <h3>Conclusion</h3> Favorable aortic remodeling is a strong and independent predictor of long-term survival and freedom from reintervention after thoracic endovascular aortic repair for chronic type B aortic dissection. These findings suggest that intervening earlier in the chronic phase, before substantial aortic dilatation develops, may be beneficial for improving clinical outcomes.