title: Early results of endovascular treatment of the thoracic aorta using the Valiant endograft.
abstract: Endovascular repair of the thoracic aorta has been adopted as the first-line therapy for much pathology. Initial results from the early-generation endografts have highlighted the potential of this technique. Newer-generation endografts have now been introduced into clinical practice and careful assessment of their performance should be mandatory. This study describes the initial experience with the Valiant endograft and makes comparisons with similar series documenting previous-generation endografts. Data were retrospectively collected on 180 patients treated with the Valiant endograft at seven European centers between March 2005 and October 2006. The patient cohort consisted of 66 patients with thoracic aneurysms, 22 with thoracoabdominal aneurysms, 19 with an acute aortic syndrome, 52 with aneurysmal degeneration of a chronic dissection, and 21 patients with traumatic aortic transection. The overall 30-day mortality for the series was 7.2%, with a stroke rate of 3.8% and a paraplegia rate of 3.3%. Subgroup analysis demonstrated that mortality differed significantly between different indications; thoracic aneurysms (6.1%), thoracoabdominal aneurysms (27.3%), acute aortic syndrome (10.5%), chronic dissections (1.9%), and acute transections (0%). Adjunctive surgical procedures were required in 63 patients, and 51% of patients had grafts deployed proximal to the left subclavian artery. Comparison with a series of earlier-generation grafts demonstrated a significant increase in complexity of procedure as assessed by graft implantation site, number of grafts and patient comorbidity. The data demonstrate acceptable results for a new-generation endograft in series of patients with diverse thoracic aortic pathology. Comparison of clinical outcomes between different endografts poses considerable challenges due to differing case complexity.
authors: St George's Vascular Institute, 4th Floor St James Wing, St George's Hospital NHS Trust, Blackshaw Road, London SW17 0QT, UK. matt.thompson@stgeorges.nhs.uk
authors: Matt
authors: M
authors: Thompson
authors: Stella
authors: S
authors: Ivaz
authors: Nicholas
authors: N
authors: Cheshire
authors: Rosella
authors: R
authors: Fattori
authors: Herve
authors: H
authors: Rousseau
authors: Robin
authors: R
authors: Heijmen
authors: Jean-Paul
authors: JP
authors: Beregi
authors: Frederic
authors: F
authors: Thony
authors: Gillian
authors: G
authors: Horne
authors: Robert
authors: R
authors: Morgan
authors: Ian
authors: I
authors: Loftus
mesh_terms: D000328:Adult; D000368:Aged; D001013:Aorta, Thoracic; D001018:Aortic Diseases / Q000473:pathology / Q000628:therapy*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome