Endovascular treatment of acute and chronic aortic dissection: midterm results from the Talent Thoracic Retrospective Registry.
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.
Kische
Stephan
S
Department of Cardiology, Division of Cardiology, University Hospital Rostock, Rostock, Germany.
Ehrlich
Marek P
MP
Nienaber
Christoph A
CA
Rousseau
Hervé
H
Heijmen
Robin
R
Piquet
Philippe
P
Ince
Hüseyin
H
Beregi
Jean-Paul
JP
Fattori
Rossella
R
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
D003287:Contrast Media