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


CONCLUSIONS
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.
Ehrlich
Marek P
MP
Department of Cardiothoracic Surgery, University of Vienna, Vienna, Austria.
Nienaber
Christoph A
CA
Rousseau
Hervé
H
Beregi
Jean-Paul
JP
Piquet
Philippe
P
Schepens
Marc
M
Bartoli
Jean-Michelle
JM
Schillinger
Martin
M
Fattori
Rossella
R
D000704:Analysis of Variance; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D000792:Angiography; D017130:Angioplasty / Q000009:adverse effects / Q000379:methods*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D012042:Registries; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D015607:Stents; D016019:Survival Analysis; D013908:Thoracotomy / Q000379:methods / Q000706:statistics & numerical data; D013997:Time Factors; D016896:Treatment Outcome