Endovascular treatment of acute and chronic aortic dissection: Midterm results from the Talent Thoracic Retrospective Registry

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.

CTSNet classification: 33

Abbreviations and Acronyms: ASA, American Society of Anesthesiologists, CI, confidence interval, CT, computed tomography, MRI, magnetic resonance imaging, OR, odds ratio, TTR, Talent Thoracic Retrospective Registry