Endovascular stent-graft treatment of aortic dissection: determinants of post-interventional outcome.
OBJECTIVE
To investigate the results of endovascular stent-graft placement for the treatment of patients with type B aortic dissection (B-AD).


RESULTS
A total of 38 patients (62+/-10 years, 32 male) with acute (n=10) and chronic (n=28) type B-AD were treated with endovascular stent-grafts. The implantation procedure was successful in all patients. Peri-procedural non-fatal complications occurred in four (11%) patients. Overall, 4/38 (11%) patients died during the in-hospital period. Patients undergoing stent-graft placement for acute AD had a significantly higher in-hospital mortality than patients with chronic AD (40 vs. 0%, P=0.001). During a median follow-up of 18 (1-57) months, there were six additional deaths. Overall survival rates were 97.4+/-2.6% at 30 days, 80.4+/-6.7% at 1 year, 73.2+/-7.8% at 2 years, and 54.9+/-16.9% at 4 years. Patients with a poor clinical health status (ASA class > 3) had a significantly reduced life expectancy compared with patients with only moderate co-morbidities (ASA class </= 3) (1-year survival rate 28.6+/-17.1 vs. 92.6+/-6.7%, P=0.0001). Multivariable analysis revealed that a poor clinical health status (ASA>3) pre-operatively (HR=29.5, 95% CI 1.5-581.9, P=0.026) and increased age (HR=1.1, 95% CI 0.9-1.2, P=0.084) were independent determinants of post-interventional mortality.


CONCLUSIONS
Endovascular stent-graft treatment is a safe alternative for patients with AD. The pre-operative clinical health status of the patient is the most important determinant of post-interventional outcome. Careful patient selection is thus of particular importance.
Eggebrecht
Holger
H
Department of Cardiology, West-German Heart Centre Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany. holger.eggebrecht@uni-essen.de
Herold
Ulf
U
Kuhnt
Oliver
O
Schmermund
Axel
A
Bartel
Thomas
T
Martini
Stefan
S
Lind
Alexander
A
Naber
Christoph K
CK
Kienbaum
Peter
P
Kühl
Hilmar
H
Peters
Jürgen
J
Jakob
Heinz
H
Erbel
Raimund
R
Baumgart
Dietrich
D
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001019:Aortic Rupture / Q000000981:diagnostic imaging / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods; D002908:Chronic Disease; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D015607:Stents; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome