Conclusion:The Talent thoracic stent graft appears effective in the treatment of both acute and chronic diseases of the thoracic aorta.Summary: This report derives from the Talent Thoracic Retrospective Registry. It includes treatment of patients in seven major European referral centers during an 8-year period. The Talent thoracic stent graft was used to treat thoracic aortic pathology in 457 consecutive patients, of which 113 were emergent cases and 344 were elective. Median follow-up was 24 Ϯ 19 months (range, 1 to 85.1 months). Follow-up was based on clinical and imaging findings. Adverse events were included, and all adverse events were reviewed by a single physician.In-hospital mortality was 5% (23 patients). Mortality was 8.5% during follow-up of the 422 patients who survived the initial procedure. Thirty-six patients died, and 11 of the deaths were related to aortic disease. Specific procedure-related complications included stroke in 3.7%, paraplegia in 1.7%, and local vascular access-site complications in 3.3%. Two patients died of aortic rupture during placement of the device.Persistent endoleak was documented in 64 cases, of which 43 demonstrated primary endoleak present at the end of the procedure, and 21 endoleaks were discovered during follow-up. There were 7 patients with persistent endoleak with aortic rupture during the follow-up period. Aortic rupture associated with persistent endoleak occurred from 40 days to 35 months. All patients with aortic rupture associated with persistent endoleak died. Stent graft migration occurred in seven cases, graft fabric failure in two, and known modular disconnection in three. Survival was 90.97% at 1 year, 85.36% at 3 years, and 77.49% at 5 years. Freedom from a second procedure, endovascular, or open conversion, at 1, 3 and 5 years was 92.41%, 81.3%, and 70.0%, respectively.Comment: These are registry data and are thus subject to all the limitations of such data. Patients were treated for a variety of acute and chronic conditions. Although patients were acquired during an 8-years period, only 95 patients had Ͼ3 years of clinical and imaging follow-up available. The data suggest the Talent thoracic aortic stent graft can be deployed with a reasonable rate of complications for a variety of thoracic aortic pathologies. Further follow-up is obviously required to establish long-term efficacy. D-dimer testing to determine the duration of anticoagulation therapy

† This joint statement, which represents the views of the EACTS and the ESC, was arrived at after careful consideration of the available evidence at the time it was written. Health professionals are encouraged to take the joint statement fully into account when exercising their clinical judgement. The joint statement does not, however, override the individual responsibility of health professionals to make appropriate decisions in the circumstances of the individual patients, in consultation with that patient, and where appropriate and necessary the patient's guardian or carer. It is also the health professional's responsibility to verify the rules and regulations applicable to drugs and devices at the time of prescription.

interval, 2.71-2.81) compared with never smokers. This was despite the fact that 44% of the baseline smokers who responded to the 8-year resurvey had stopped smoking at that point. Mortality was tripled, largely irrespective of age, in those still smoking at the 3-year resurvey (rate ratio, 2.97; 2.88-3.07). The 12-year mortality was doubled (rate ratio, 1.98; 1.91-2.04) even for women smoking fewer than 10 cigarettes daily at baseline. Of the 30 most common causes of death, 23 were increased significantly in smokers. Excess mortality was mainly from diseases caused by smoking. Among ex-smokers who stopped permanently at ages 25 to 34 or at ages 35 to 44 years, the respective relative risks were 1.05 (95% confidence interval, 1.00-1.11) and 1.20 (1.14-1.26) for all-cause mortality and 1.84 (1.45-2.34) and 3.34 (2.76-4.03) for lung cancer mortality. Comment: Please see also the report by Jha P et al providing similar data from the United States, also featured in this Abstract Section of the Journal. The data are remarkably similar between the two countries. In particular, it is important to note that although some excess mortality remains among long-term ex-smokers, it is only about 3% and 10% of excess mortality among continued smokers. If the data in this study were combined with the 2010 U.K. national death rates, it would indicate 53% of smokers and 22% of never smokers die before age 80 years with an 11year lifespan difference in favor of the never smokers.

Given the spectrum of different pathologies that affect the descending thoracic aorta, it is important to define whether the outcome of TEVAR is pathology specific to refine procedural technique and endograft design. Careful analysis of long-term Background-Endovascular repair of the thoracic aorta has become an increasingly utilized therapy. Although the shortterm mortality advantage over open surgery is well documented, late mortality and the impact of presenting pathology on long-term outcomes remain poorly reported. Methods and Results-A database was built from 5 prospective studies and a single institutional series. Rates of perioperative adverse events were calculated, as were midterm death and reintervention rates. Multivariate analysis was performed with the use of logistic regression modeling. Kaplan-Meier survival curves were drawn for midterm outcomes. The database contained 1010 patients: 670 patients with thoracic aortic aneurysm, 195 with chronic type B aortic dissection, and 114 with acute type B aortic dissection. Lower elective mortality was observed in patients with chronic dissections (3%) compared with patients with aneurysms (5%). Multivariate analysis identified age, mode of admission, American Society of Anesthesiologists grade, and pathology as independent predictors of 30-day death (P < 0.05). In the midterm, the all-cause mortality rate was 8, 4.9, and 3.2 deaths per 100 patient-years for thoracic aortic aneurysm, acute type B aortic dissection, and chronic type B aortic dissection, respectively. The rates of aortic-related death were 0.6, 1.2, and 0.4 deaths per 100 patient-years for thoracic aortic aneurysm, acute type B aortic dissection, and chronic type B aortic dissection, respectively. Conclusions-This study indicated that the midterm outcomes of endovascular repair of the thoracic aorta are defined by presenting pathology, associated comorbidities, and mode of admission. Nonaortic mortality is high in the midterm for patients with thoracic aortic aneurysm, and managing modifiable risk factors appears vital. Endovascular repair of the thoracic aorta results in excellent midterm protection from aortic-related mortality, regardless of presenting pathology. (Circulation. 2013;127:24-32.)