title: Aortic pathology determines midterm outcome after endovascular repair of the thoracic aorta: report from the Medtronic Thoracic Endovascular Registry (MOTHER) database.
abstract: BACKGROUND
  Endovascular repair of the thoracic aorta has become an increasingly utilized therapy. Although the short-term mortality advantage over open surgery is well documented, late mortality and the impact of presenting pathology on long-term outcomes remain poorly reported.
  
  
  RESULTS
  A database was built from 5 prospective studies and a single institutional series. Rates of perioperative adverse events were calculated, as were midterm death and reintervention rates. Multivariate analysis was performed with the use of logistic regression modeling. Kaplan-Meier survival curves were drawn for midterm outcomes. The database contained 1010 patients: 670 patients with thoracic aortic aneurysm, 195 with chronic type B aortic dissection, and 114 with acute type B aortic dissection. Lower elective mortality was observed in patients with chronic dissections (3%) compared with patients with aneurysms (5%). Multivariate analysis identified age, mode of admission, American Society of Anesthesiologists grade, and pathology as independent predictors of 30-day death (P < 0.05). In the midterm, the all-cause mortality rate was 8, 4.9, and 3.2 deaths per 100 patient-years for thoracic aortic aneurysm, acute type B aortic dissection, and chronic type B aortic dissection, respectively. The rates of aortic-related death were 0.6, 1.2, and 0.4 deaths per 100 patient-years for thoracic aortic aneurysm, acute type B aortic dissection, and chronic type B aortic dissection, respectively.
  
  
  CONCLUSIONS
  This study indicated that the midterm outcomes of endovascular repair of the thoracic aorta are defined by presenting pathology, associated comorbidities, and mode of admission. Nonaortic mortality is high in the midterm for patients with thoracic aortic aneurysm, and managing modifiable risk factors appears vital. Endovascular repair of the thoracic aorta results in excellent midterm protection from aortic-related mortality, regardless of presenting pathology.
authors.affiliation: St. George's Vascular Institute, 4th Floor, St. James Wing, St. George's Hospital National Health Service Trust, London SW17 0QT, United Kingdom.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Patterson
authors.forename: Peter
authors.initials: P
authors.lastname: Holt
authors.forename: Chrisoph
authors.initials: C
authors.lastname: Nienaber
authors.forename: Richard
authors.initials: R
authors.lastname: Cambria
authors.forename: Ronald
authors.initials: R
authors.lastname: Fairman
authors.forename: Matt
authors.initials: M
authors.lastname: Thompson
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000401:mortality / Q000473:pathology / Q000601:surgery; D001013:Aorta, Thoracic / Q000473:pathology / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D002908:Chronic Disease; D002986:Clinical Trials as Topic; D016208:Databases, Factual / Q000706:statistics & numerical data; D057510:Endovascular Procedures / Q000401:mortality*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012042:Registries / Q000706:statistics & numerical data*; D016896:Treatment Outcome