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Emergency treatment of the thoracic aorta: results in 113 consecutive acute patients (the Talent Thoracic Retrospective Registry)

^a Department of Cardiothoracic Surgery, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands
^b Department of Radiology, Centre Hospitalier Universitaire, Hôpital de Rangueil, Toulouse, France
^c Division of Cardiology, University Hospital Rostock, Rostock, Germany
^d Department of Cardiothoracic Surgery, University of Vienna, Vienna, Austria
^e Department of Vascular Surgery, Centre Hospitalier Universitaire, Hôpital Sainte Marguerite, Marseille, France
^f Radiologie Vasculaire, Hôpital Cardiologique CHRU de Lille, Lille, France
^g Cardiovascular Radiology, University Hospital S. Orsola, Bologna, Italy

Received 8 February 2008; received in revised form 20 October 2008; accepted 27 October 2008.

^_* Corresponding author. Tel.: +31 30 609 2047; fax: +31 30 609 2120. (Email: r.heijmen{at}antonius.net).

Background: Elective thoracic endovascular aortic repair in selected patients with suitable aortic anatomy is associated with low morbidity and mortality, and is gaining widespread acceptance. Its benefit in acute thoracic aorta diseases, however, has not yet been demonstrated in high-numbered studies. This report presents data of the Talent Thoracic Retrospective Registry (TTR) of all patients who underwent endovascular stent grafting for acute thoracic aorta pathology. Methods: Between December 1996 and July 2004 data were collected regarding 113 consecutive patients who underwent emergent endovascular stent grafting of the thoracic aorta using the Talent thoracic stent graft (Medtronic, Inc., Santa Rosa, California) in 7 European referral centers. Acute thoracic aorta pathology consisted of 41 (36.3 %) traumatic aortic injuries, 37 (32.7 %) Stanford type B dissections, 5 (4.4 %) intramural hematomas, 18 (15.9 %) thoracic aorta aneurysms, 4 (3.5 %) pseudoaneurysms and 8 (7.1 %) penetrating ulcers. Results: In all patients the stent graft system could be introduced via the common femoral artery. Conversion to open surgical repair was necessary in 2 patients, one in the early phase due to persistent bleeding via backflow in the false lumen from a distal entry tear, and another patient in a late phase due to retrograde dissection. Intraoperative mortality was 1.8%, one patient suffered a massive myocardial infarction, and another died of tamponade secondary to retrograde dissection. Overall hospital mortality was 8.0% (9 patients). In only 2 of them, it was considered a stent graft procedure related death. New neurological symptoms were seen in 6.2% (7 patients), with complete recovery in 5 patients. Mean follow-up was 15 months (range 1–69 months). Late mortality was 8.7% (9 patients). Only one late death was considered aorta related. Overall re-intervention rate was 8.9% (n = 10) and was mainly for type I endoleak or persistent false lumen perfusion. Conclusion: Sub-analysis of the Talent Thoracic Retrospective Registry for endovascular stent grafting of acute thoracic aorta pathology in over 100 consecutive patients demonstrated its feasibility, with low morbidity and acceptable low mortality rates.

Key Words: Endovascular procedures/stents • Aortic dissection • Aneurysm aorta