title: Late outcomes of a single-center experience of 400 consecutive thoracic endovascular aortic repairs.
abstract: BACKGROUND
  In this study, we report the late outcomes of a large, decade-long single-center thoracic endovascular aortic repair experience.
  
  
  RESULTS
  A prospectively maintained registry and the electronic medical records of 400 consecutive thoracic endovascular aortic repair performed at a tertiary care center were reviewed. The distribution of pathologies treated included aneurysms (198, 49%), dissections (100, 25%), penetrating ulcers (54, 14%), traumatic transections (25, 6%), and other pathologies (23, 6%). Spinal drains were placed prophylactically in 127 cases (32%) of planned extended aortic coverage. There were no acute surgical conversions. Adjunctive surgical procedures were performed on 94 patients (24%). Subclavian revascularizations were performed selectively in only 15% of zone 0 to 2 deployments. The median length of stay was 5 days (limits, 1 and 79 days). Overall 30-day mortality was 6.5% (elective, 2.6%; urgent, 9.5%; and emergent, 20%). Permanent spinal cord ischemia occurred in 4.5% and stroke in 3%. Kaplan-Meier estimates of survival were 82%, 76%, 68%, and 60% and freedom from secondary intervention was 90%, 86%, 81%, and 78% at 6, 12, 24, and 36 months, respectively. Risk factors for mortality included stroke, urgent/emergent repair, age ≥80 years, general anesthesia, and dissection pathology.
  
  
  CONCLUSIONS
  Thoracic endovascular aortic repair may be used to treat a variety of thoracic aortic pathologies with a very low risk of intraoperative conversion. Overall rates of mortality and neurological complications were relatively low but significantly increased in emergent repairs. There appeared to be a substantial number of late deaths, which may represent a combination of poor patient selection and treatment failures.
authors.affiliation: Director of Endovascular Program, Christine E. Lynn Heart and Vascular Institute, 670 Glades Road, Boca Raton, FL 33431, USA. walee@sapbc.net
authors.forename: W Anthony
authors.initials: WA
authors.lastname: Lee
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Daniels
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Beaver
authors.forename: Charles T
authors.initials: CT
authors.lastname: Klodell
authors.forename: Dan E
authors.initials: DE
authors.lastname: Raghinaru
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Hess
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000293:injuries / Q000473:pathology / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000601:surgery; D001018:Aortic Diseases / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014456:Ulcer / Q000401:mortality / Q000601:surgery; D014656:Vascular Surgical Procedures; D055815:Young Adult