Thoracic aortic endografting in patients with high risk for open surgery

Introduction: Out of 154 patients who underwent endografting at our institution between 07/1999 and 09/2005, 124 (80.5%) were at high risk for open thoracic aortic surgery. Our 8-year experience in this subgroup [84 male, 20 female patients; age 62 (16–88) years] is reviewed.

Methods: Patients were considered at high risk if one of the following was present: rupture; malperfusion in dissections; previous descending aortic surgery; age >70 years; obesity (body mass index (BMI) >30); cachexia (BMI <20); COPD; unstable angina or arrhythmia, poorly compensated congestive heart failure; systemic infection; coagulation disorder. Indications were based on degenerative aneurysms (n=21), penetrating atherosclerotic ulcers (n=32), type-B dissections (n=33), acute traumatic ruptures (n=28), suture aneurysms (n=7) and others (n=3). Stent grafts were implanted in the operating room by a team of cardiovascular surgeons: 89 Talent®, 31 E-vita®, 3 Zenith®, and 1 Endofit® grafts.

Results: The following results were achieved (figures for the low-risk-group given in parenthesis): 30-day mortality 14.5% (0%), paraplegia 1.6% (0%), stroke 4.8% (3.3%), primary technical success 85% (90%); secondary technical success after further interventions 92% (100%).

Conclusion: Mortality and incidence of paraplegia after thoracic aortic endografting compare favorably to the rates found with conventional surgery, even in the surgical high-risk group. Results of endografting in the surgical low-risk group are excellent. Therefore endografting is the treatment of choice whenever it is anatomically suitable.