Mid-Term Results of Endovascular treatment of acute and chronic aortic dissection: The Talent Thoracic Retrospective Registry (TTR)
Marek P. Ehrlich1, Stephan Kische2, Herve Rousseau3, Robin Heijmen4, Philippe Piquet5, Jean-Paul Beregi6, Christoph A. Nienaber2, Rossella Fattori7; 1Dept. Cardiothoracic Surgery, Univ. Hospital Vienna, Vienna, Austria; 2Division of Cardiology, Univ. Hospital Rostock, Rostock, Germany; 3Dept. of Radiology, Hopital de Rangueil, Toulouse, France; 4Dept. Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, Netherlands; 5Hopital Sainte Marguerite, Marseille, France; 6Hopital Cardiologique CHRU, Lille, France; 7Cardiovascular Radiology, Univ. Hospital S. Orsola, Bologna, Italy
Comment on this Abstract
Objective: This study examined results after endovascular Talent® Thoracic stent-graft treatment in patients with acute or chronic aortic dissection.
Methods: 180 patients were treated for acute or chronic dissection (mean age= 59 ± 13 yr). Thirty- seven (21%) patients had acute aortic complications with rupture, distal malperfusion or persistent pain; the remainder were stable. Aortic diameter was 54± 14 (range 26 - 136) mm, the distance from the left subclavian artery to proximal entry tear was 44± 42 (range 0 - 220) mm, and dissection extended beyond the celiac axis in 88%. Length of covered aorta was 139 (range 28-380) mm; one stent-graft unit was used in 125 (69%) of cases.
Results: Procedural success was 98%. Eight patients died early for an in-hospital mortality rate of 4.4% (14% for those with acute complications vs. 2% for elective cases [p= 0.003]). In-hospital complications, including fatal and non-fatal major adverse events, also occurred more frequently in patients with acute aortic complications (41 vs. 11%, p <0.001), especially neurological complications (16% vs. 4.2% , p=0.01). Acute patients with a smaller aortic diameter had fewer secondary endoleaks. Multivariate logistic regression analysis showed that age 75 ≥ years (OR 4.9 ; 95% CI 1.6-15.1; p=0.006), ASA class IV/V (OR 2.8; 95% CI 1.0-7.5; p=0.04) and emergency status (OR 3.5; 95% CI 1.3-8.9; p=0.01) were independent predictors of in-hospital adverse events.
Average follow-up for hospital survivors was 22.3 ± 17 (1-71) months. Overall Kaplan-Meier survival estimate was 95±2% at 30 days, 91±2% at 12 months, 91±2% at 24 months, and 82±5% at 36 months. For patients with acute complications, survival was 86±6% at 30 days, 83±6% at 12 months, and 83±6% at 3 years. Survival estimate for elective patients were 97+1% at 30 days, 93+2% at 12 months, and 82+6% at 3 years (Figure 1). Follow-up imaging revealed a lower rate of progressive aortic enlargement in acute vs. chronic dissections (3.2% vs. 23%, p=0.001).
Conclusion: Endovascular treatment for aortic dissection is associated with reasonably low morbidity and mortality rates. Longer-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.
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