Midterm outcome in 158 consecutive Gore TAG thoracic endoprostheses: single center experience.

Abstract

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.

• Authors: Grayson H Wheatley 3rd, Ahmet Tayfun Gurbuz, Julio A Rodriguez-Lopez, Venkatesh G Ramaiah, Dawn Olsen, James Williams, Edward B Diethrich
• Journal: The Annals of thoracic surgery (Ann Thorac Surg) Vol. 81 Issue 5 Pg. 1570-7; discussion 1577 (May 2006) ISSN: 1552-6259 [Electronic] Netherlands
• PMID: 16631636 (Publication Type: Clinical Trial, Journal Article)

Topics

• Aged
• Aged, 80 and over
• Aortic Dissection (diagnostic imaging, epidemiology, surgery)
• Aortic Aneurysm, Thoracic (diagnostic imaging, epidemiology, surgery)
• Blood Vessel Prosthesis
• Blood Vessel Prosthesis Implantation
• Female
• Humans
• Male
• Prospective Studies
• Prosthesis Design
• Stents
• Treatment Outcome
• Ultrasonography, Interventional