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Ann Thorac Surg 2006;81:1570-1577
© 2006 The Society of Thoracic Surgeons
a Department of Cardiovascular Surgery, Arizona Heart Institute, Phoenix, Arizona
b Department of Cardiovascular Surgery, Anadolu Saglik Merkezi, Kocaeli, Turkey
Accepted for publication June 24, 2005.
* Address correspondence to Dr Wheatley, Arizona Heart Institute, 2632 N 20th Street, Phoenix, AZ 85006 (Email: gwheatley{at}azheart.com).
Presented at the Forty-first Annual Meeting of The Society of Thoracic Surgeons, Tampa, FL, Jan 24–26, 2005.
BACKGROUND: Despite recent improvements in surgical technique, some patients with descending thoracic aortic pathologies are unable to undergo open surgical repair due to significant comorbidities and/or unfavorable thoracic aortic anatomy. Some of these patients might be able to tolerate a less invasive approach, such as endoluminal grafting. We reviewed our consecutive clinical experience with the Gore TAG endoprosthesis (W. L. Gore & Assoc, Flagstaff, AZ) for the endovascular exclusion of assorted descending thoracic aortic pathologies in higher surgical risk patients.
METHODS: After obtaining institutional review board approval, 158 high surgical risk patients underwent attempted delivery of a Gore TAG thoracic endoprosthesis between February 2000 and July 2004. Indications for study enrollment were atherosclerotic aneurysm (n = 76), aortic dissection (n = 36), penetrating aortic ulcer (n = 15), contained rupture (n = 11), pseudoaneurysm (n = 10), traumatic aortic injury (n = 5), aortobronchial fistula (n = 4), and aortic coarctation (n = 1).
RESULTS: The device was successfully delivered in 156 (98.7%) patients. Mean patient age was 72 ± 12.1 years. Three (1.9%) patients developed transient paraparesis after graft deployment and 1 (0.6%) patient developed paraplegia. While postimplantation endoleaks were observed in 18 (11.5%) patients, only 12 patients required reintervention. Thirty-day mortality was 3.8% (6 of 156). Mean follow-up was 21.5 ± 18.8 months, and the overall mortality was 17.3% (27 of 156).
CONCLUSIONS: Endoluminal grafting of multiple types of descending thoracic aorta pathologies with the Gore TAG thoracic endoprosthesis is feasible and safe in higher surgical risk patients. Additional studies and long-term follow-up of these patients are warranted.
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