Abstract 19406: Midterm Results After Endovascular Treatment of Acute, Complicated Type B Aortic Dissection: The Talent Thoracic Registry
Purpose: To assess the efficacy and midterm results of endovascular treatment of acute complicated type B dissection.
Methods: Between January 1998 and March 2004, 29 patients (7 female, 22 male) with acute complicated aortic type B dissections (mean age 61, range 22 – 78 years), defined as either aortic rupture, malperfusion, intractable pain or uncontrolled hypertension underwent endovascular stent graft placement with the Medtronic Talent device. Five patients (17%) had undergone previous surgery on the ascending aorta and/or aortic valve. Mean aortic diameter at time of intervention was 48 ± 13 mm. Follow-up was 100% complete and averaged 30 ± 29 months.
Results: Technical feasibility and success with deployment proximal to the entry tear was 100%, requiring partial or total coverage of the left subclavian artery in only one patient (3%). Hospital mortality was 17 % ± 7 % (70% confidence limit) with 3 late deaths (6, 36 and 38 months post implant). Causes of hospital death included cardiac failure in three patients and aortic rupture in 2. Three patients (10 %) who survived the procedure developed neurological complications (2 strokes, 1 TIA). One patient required early conversion to surgery due to persistent bleeding. Furthermore, five patients developed a Type Ia Endoleak. Postprocedural increase in the distal aortic diameter was observed in 3 patients. Actuarial survival at 1 and 5 years was 79 % and 72 %, respectively. Freedom from treatment failure at 1 and 5 years (including reintervention, aortic rupture, device related complication, aortic related death, or sudden, unexplained late death) was 78 % and 72 %.
Conclusions: Endovascular stent-graft placement in acute complicated type B aortic dissection proves to be a promising alternative therapeutic treatment modality in this relatively difficult patient cohort. Refinements, especially in stent design and application, may further improve the prognosis of patients in this life-threatening situation.
- © 2010 by American Heart Association, Inc.