• 作者：Marek P. Ehrlich ; MD^a ; ^{marek.ehrlich@meduniwien.ac.at} ; Herve Rousseau ; MD^b ; Robin Heijmen ; MD^c ; Philippe Piquet ; MD^d ; Jean-Paul Beregi ; MD^e ; Christoph A. Nienaber ; MD^f ; Gottfried Sodeck ; MD^g ; Rossella Fattori ; MD^h
• 关键词：26
• 刊名：The Journal of Thoracic and Cardiovascular Surgery
• 出版年：2013
• 出版时间：January, 2013
• 年：2013
• 卷：145
• 期：1
• 页码：159-165
• 全文大小：460 K

Objective

Methods

From January 1998 to March 2004, 29 patients (7 women and 22 men) with acute complicated aortic type B dissection (mean age, 61 years; range, 22-78), defined as 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. The mean aortic diameter at intervention was 48 ¡À 13 mm. Follow-up was 100 % complete and averaged 53 ¡À 41 months.

Results

The 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 1 patient (3 % ). Hospital mortality was 17 % ¡À 7 % (70 % confidence limit) with 6 late deaths. The causes of hospital death included multiorgan failure in 2 patients, aortic rupture in 2, and retrograde dissection in 1 patient. Three patients (10 % ) who survived the procedure developed neurologic complications (2 strokes and 1 transient ischemic attack). One patient required early conversion to surgery because of retrograde type A dissection. Furthermore, 4 patients developed a type Ia endoleak. A postprocedural increase in the distal aortic diameter was observed in 3 patients. The actuarial survival at 1 and 5 years was 79 % and 61 % , respectively. Freedom from treatment failure at 1 and 5 years (including reintervention, aortic rupture, device-related complications, aortic-related death, or sudden, unexplained late death) was 82 % and 77 % , respectively.

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, could further improve the prognosis of patients in this life-threatening situation.