title: Endovascular treatment of acute and chronic aortic dissection: midterm results from the Talent Thoracic Retrospective Registry.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors: Department of Cardiology, Division of Cardiology, University Hospital Rostock, Rostock, Germany.
authors: Stephan
authors: S
authors: Kische
authors: Marek P
authors: MP
authors: Ehrlich
authors: Christoph A
authors: CA
authors: Nienaber
authors: Hervé
authors: H
authors: Rousseau
authors: Robin
authors: R
authors: Heijmen
authors: Philippe
authors: P
authors: Piquet
authors: Hüseyin
authors: H
authors: Ince
authors: Jean-Paul
authors: JP
authors: Beregi
authors: Rossella
authors: R
authors: Fattori
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000175:diagnosis / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000601:surgery*; D001019:Aortic Rupture / Q000209:etiology; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D002908:Chronic Disease; D003287:Contrast Media; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D015607:Stents / Q000009:adverse effects; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D003287:Contrast Media