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J Thorac Cardiovasc Surg 2008;135:1322-1326
© 2008 The American Association for Thoracic Surgery

Evolving Technology

Short-term conversion to open surgery after endovascular stent-grafting of the thoracic aorta: The Talent thoracic registry

^a Department of Cardiothoracic Surgery, University of Vienna, Vienna, Austria
^b Department of Cardiology, University Hospital Rostock, Rostock, Germany
^c Department of Radiology, Centre Hospitalier Universitaire, Hopital de Rangueil, Toulouse, France
^d Radiologie Vasculaire, Hopital Cardiologique CHRU de Lille, Lille, France
^e Centre Hospitalier Universitaire, Hopital Sainte Marguerite, Marseille, France
^f Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwagein, The Netherlands
^g Centre Hospitalier Universitaire, Hopital de la Timone, Marseille, France
^h Department of Internal Medicine, University of Vienna, Vienna, Austria
ⁱ Cardiovascular Radiology, University Hospital S. Orsola, Bologna, Italy

Received for publication May 28, 2007; revisions received September 2, 2007; accepted for publication September 12, 2007.

^_* Address for reprints: Rossella Fattori, MD, Department of Radiology-Cardiovascular Unit, University Hospital S. Orsola, Via Masseranti 9, 40128 Bologna, Italy. (Email: rosella.fattori{at}unibo.it).

Objective: Predictors of late conversion to conventional surgery after thoracic endovascular stent-graft placement are currently unknown.

Methods: We analyzed data from 422 of 457 consecutive patients who underwent endovascular thoracic repair with the Medtronic Talent thoracic stent-graft (Medtronic/AVE, Santa Rosa, Calif). Of these, 16 patients (3.8%) required late conversion to open surgery during a median follow-up interval of 17 months (range 7–33 months). Six of these patients had undergone previous aortic surgery, 3 patients had previous cardiac surgery, and 5 patients had Marfan syndrome. In patients with late conversion, indications for primary stent-graft placement were dissection in 10 patients, degenerative aneurysm in 5 patients, and penetrating ulcer in 1 patient.

Results: By multivariable Cox analysis, Marfan syndrome (adjusted hazard ratio 9.97, P = .008), type I endoleak (adjusted hazard ratio 3.99, P = .012), the use of more than 1 stent-graft (adjusted hazard ratio 3.89, P = .018), and procedural complications (adjusted hazard ratio 17.50, P = .003) were independent predictors of late conversion.

Conclusion: Endovascular treatment for thoracic aortic disease with the Talent stent-graft is associated with a relatively low rate of late conversion to conventional surgery. Better results may be achieved by excluding patients with Marfan syndrome for such a procedure and early aggressive treatment of early type I endoleaks.