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J Thorac Cardiovasc Surg 2006;132:332-339
© 2006 The American Association for Thoracic Surgery
Evolving Technology |
a Cardiovascular Radiology, University Hospital S. Orsola, Bologna, Italy
b Division of Cardiology, University Hospital Rostock, Rostock, Germany
c Department of Radiology, Centre Hospitalier Universitaire, Hôpital de Rangueil, Toulouse, France
d Radiologie Vasculaire, Hôpital Cariologique CHRU de Lille, Lille, France
e Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
f Department of Cardio-Thoracic Surgery, University of Vienna, Vienna, Austria
g Department of Vascular Surgery, Centre Hospitalier Universitaire, Hôpital Sainte Marguerite, Marseille, France
h Department of Interventional Radiology, Centre Hospitalier Universitaire, Hôpital de la Timone, Marseille, France
Received for publication December 26, 2005; revisions received February 21, 2006; accepted for publication March 15, 2006. * Address for reprints: Rossella Fattori, Department of Radiology–Cardiovascular Unit (pad 21), University Hospital S. Orsola, Via Massarenti 9, 40128 Bologna, Italy (Email: rossella.fattori{at}unibo.it).
BACKGROUND: Endovascular treatment of thoracic aortic diseases demonstrated low perioperative morbidity and mortality when compared with conventional open repair. Long-term effectiveness of this minimally invasive technique remains to be proven. The Talent Thoracic Retrospective Registry was designed to evaluate the impact of this therapy on patients treated in 7 major European referral centers over an 8-year period.
METHODS: Data from 457 consecutive patients (113 emergency and 344 elective cases) who underwent endovascular thoracic aortic repair with the Medtronic Talent Thoracic stent graft (Medtronic/AVE, Santa Rosa, Calif) were collected. Follow-up analysis (24 ± 19.4 months, range 1-85.1 months) was based on clinical and imaging findings, including all adverse events. To ensure consistency of data interpretation and event reporting, one physician reviewed all adverse events and deaths for the whole cohort of patients. In the case of discrepancies, the treating physicians were queried.
FINDINGS: Among 422 patients who survived the interventional procedure (in-hospital mortality 5%, 23 patients), mortality during follow-up was 8.5% (36 patients), and in 11 of them the death was related to the aortic disease. Persistent endoleak was reported at imaging follow-up in 64 cases: 44 were primary (9.6%) and 21 occurred during follow-up (4.9%). Seven patients with persistent endoleak had aortic rupture during follow-up, at a variable time from 40 days to 35 months, and all subsequently died. A minor incidence of migration of the stent graft (7 cases), graft fabric alteration (2 cases), and modular disconnection (3 cases) was observed at imaging. Kaplan-Meier overall survival estimate at 1 year was 90.97%, at 3 years was 85.36%, and at 5 years was 77.49%. At the same intervals, freedom from a second procedure (either open conversion or endovascular) was 92.45%, 81.3%, and 70.0%, respectively.
CONCLUSION: Endovascular treatment for thoracic aortic disease with the Talent stent graft is associated with low early morbidity and mortality rates also for patients who are at high risk and treated on an emergency basis. Follow-up data indicate a substantial durability of the procedure with a high freedom from related death and secondary interventions.
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