Endovascular stent-graft treatment of aortic dissection: determinants of post-interventional outcome

• Published in: European heart journal 2005-03, Vol.26 (5), p.489-497
• Main Authors: Eggebrecht, Holger, Herold, Ulf, Kuhnt, Oliver, Schmermund, Axel, Bartel, Thomas, Martini, Stefan, Lind, Alexander, Naber, Christoph K., Kienbaum, Peter, Kühl, Hilmar, Peters, Jürgen, Jakob, Heinz, Erbel, Raimund, Baumgart, Dietrich
• Format: Article
• Language: English
• Subjects: Acute Disease; Adult; Aged; Aged, 80 and over; Aneurysm, Dissecting - diagnostic imaging; Aneurysm, Dissecting - surgery; Aorta; Aortic Aneurysm, Thoracic - diagnostic imaging; Aortic Aneurysm, Thoracic - surgery; Aortic Rupture - diagnostic imaging; Aortic Rupture - surgery; Biological and medical sciences; Blood and lymphatic vessels; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation - methods; Cardiology. Vascular system; Chronic Disease; Cohort Studies; Complication; Disease-Free Survival; Diseases of the aorta; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Dissection; Endovascular; Female; Follow-Up Studies; Humans; Male; Medical sciences; Middle Aged; Patient Selection; Stent; Stents; Tomography, X-Ray Computed - methods; Treatment Outcome
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/eurheartj/ehi099

Aims To investigate the results of endovascular stent-graft placement for the treatment of patients with type B aortic dissection (B-AD). Methods and results A total of 38 patients (62±10 years, 32 male) with acute (n=10) and chronic (n=28) type B-AD were treated with endovascular stent-grafts. The implantation procedure was successful in all patients. Peri-procedural non-fatal complications occurred in four (11%) patients. Overall, 4/38 (11%) patients died during the in-hospital period. Patients undergoing stent-graft placement for acute AD had a significantly higher in-hospital mortality than patients with chronic AD (40 vs. 0%, P=0.001). During a median follow-up of 18 (1–57) months, there were six additional deaths. Overall survival rates were 97.4±2.6% at 30 days, 80.4±6.7% at 1 year, 73.2±7.8% at 2 years, and 54.9±16.9% at 4 years. Patients with a poor clinical health status (ASA class > 3) had a significantly reduced life expectancy compared with patients with only moderate co-morbidities (ASA class ≤ 3) (1-year survival rate 28.6±17.1 vs. 92.6±6.7%, P=0.0001). Multivariable analysis revealed that a poor clinical health status (ASA>3) pre-operatively (HR=29.5, 95% CI 1.5–581.9, P=0.026) and increased age (HR=1.1, 95% CI 0.9–1.2, P=0.084) were independent determinants of post-interventional mortality. Conclusion Endovascular stent-graft treatment is a safe alternative for patients with AD. The pre-operative clinical health status of the patient is the most important determinant of post-interventional outcome. Careful patient selection is thus of particular importance.