Document Detail


Endovascular treatment of acute and chronic aortic dissection: midterm results from the Talent Thoracic Retrospective Registry.
MedLine Citation:
PMID:  19577067     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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. CONCLUSION: 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:
Stephan Kische; Marek P Ehrlich; Christoph A Nienaber; Hervé Rousseau; Robin Heijmen; Philippe Piquet; Hüseyin Ince; Jean-Paul Beregi; Rossella Fattori
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Publication Detail:
Type:  Journal Article; Multicenter Study    
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  138     ISSN:  1097-685X     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2009 Jul 
Date Detail:
Created Date:  2009-07-06     Completed Date:  2009-07-28     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  115-24     Citation Subset:  AIM; IM    
Affiliation:
Department of Cardiology, Division of Cardiology, University Hospital Rostock, Rostock, Germany.
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Adult
Aged
Aged, 80 and over
Aneurysm, Dissecting / diagnosis,  surgery*
Aortic Aneurysm, Thoracic / diagnosis,  surgery*
Aortic Rupture / etiology
Blood Vessel Prosthesis Implantation* / adverse effects
Chronic Disease
Contrast Media
Female
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Reoperation
Stents* / adverse effects
Tomography, X-Ray Computed
Young Adult
Chemical
Reg. No./Substance:
0/Contrast Media

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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