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J Thorac Cardiovasc Surg 2009;138:115-124
© 2009 The American Association for Thoracic Surgery
Evolving Technology/Basic Science |
a Department of Cardiology, Division of Cardiology, University Hospital Rostock, Germany
b Department of Cardiothoracic Surgery, University of Vienna, Austria
c Department of Radiology, Centre Hospitalier Universitaire, Hopital de Rangueil, Toulouse, France
d Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, The Netherlands
e Centre Hospitalier Universitaire, Hopital Sainte Marguerite, Marseille, France
f Radiologie Vasculaire, Hopital Cardiologique CHRU de Lille, Lille, France
g Cardiovascular Radiology, University Hospital S. Orsola, Bologna, Italy
Received for publication May 9, 2008; revisions received July 11, 2008; accepted for publication July 26, 2008. * Address for reprints: Christoph A. Nienaber, MD, Department of Cardiology, University of Rostock, D-18057 Rostock, Germany. (Email: christoph.nienaber{at}med.uni-rostock.de).
Objective: This study examined midterm results after treatment with the endovascular Talent thoracic stent graft (Medtronic/AVE, Santa Rosa, Calif) in patients with acute or chronic aortic dissection.
Methods: In the Talent Thoracic Retrospective Registry, 180 patients were treated for acute or chronic aortic dissection (mean age: 59.6 ± 13.0 years). Thirty-seven (20.6%) patients had acute aortic complications with signs of rupture, distal malperfusion, or persistent pain; the remainder were in stable condition. Aortic diameter was 53.5 ± 14.3 mm, the distance from the left subclavian artery to the proximal entry tear was 44.1 ± 41.9 mm, and dissection extended beyond the celiac axis in 88.3% of cases. Length of covered aorta measured 138.9 ± 45.7 mm, with one stent graft used in 125 (69.4%) patients.
Results: Procedural success was 98.3%. Nine patients died within 30 days, yielding an overall early mortality of 5.0%. For in-hospital outcome, multivariate analysis showed that age greater than 75 years (odds ratio [OR] 4,9; 95% confidence intervals [CI] 1.6–15.1; P = .006), American Society of Anesthesiologists class greater than III (OR 2.8; 95% CI 1.0–7.5; P = .04), and emergency status (OR 3.5; 95% CI 1.3–8.9; P = .01) were independent predictors of major adverse events. Compared with electively treated patients, emergency status was associated with a higher incidence of in-hospital mortality (13.5% vs 2.1%; P = .003) and neurologic events (16.2% vs 4.2%; P = .01). However, patients with acute dissection had a smaller baseline diameter and were less often identified to have secondary endoleaks and progressive enlargement. Average follow-up for hospital survivors was 22.3 ± 17.0 months with an estimated survival of 94.9% ± 1.7% at 30 days, 90.6% ± 2.3% at 12 months, 90.6% ± 2.3% at 24 months, and 81.8% ± 4.8 % at 36 months. During follow-up, 30 patients required a total of 32 secondary interventions including 12 open and 20 endovascular procedures, accounting for an estimated 71.5% freedom from reinterventions at 36 months. Follow-up imaging revealed stable or decreasing thoracic aortic diameter in 80.5% of patients.
Conclusion: Endovascular treatment for aortic dissection is associated with reasonably low morbidity and mortality. Long-term surveillance is crucial to define more comprehensively the durability of stent graft treatment of aortic dissection and to determine which patients are appropriate candidates for stent graft therapy.
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