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J Thorac Cardiovasc Surg 2007;133:375-376
© 2007 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Discussion

Dr Joseph S. Coselli (Houston, Tex). Scott, congratulations on an outstanding presentation and for bringing this information from a multicenter clinical trial to us. I believe that your report will be a seminal investigation into an evolving technology that stands to forever alter the way we therapeutically approach descending thoracic aortic pathology. Although I believe that aortic stenting is here to stay, we must shun the pressure of industry-driven initiatives and pursue good science and good medicine with, of course, industry support. We need to shoulder the responsibility of being the patient’s primary advocate.

You and the coauthors importantly infer the problems associated with a nonrandomized multicenter trial. I continue to have problems with the control group. Most of the control subjects, 53%, were historically and retrospectively acquired. Not all institutions contributed patients to this cohort. Data on aortic characteristics were unavailable in many of the open reconstruction control patients. Proximal and distal aortic diameters and aneurysm length, for example, were reported in less than 35% of this cohort; even aneurysm diameter data were missing in 10%. The data support that the open repair group did not end up with more advanced disease because they had larger aortic diameters and were more likely to be symptomatic.

After endograft repair, 17% of the . . . [Full Text of this Article]

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