Aortic Pathology Determines Midterm Outcome After Endovascular Repair of the Thoracic Aorta. Report from the Medtronic Thoracic Endovascular Registry (MOTHER) Database

Abstract

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.

Factors favoring retrograde aortic dissection after endovascular aortic arch repair

“…We can speculate that these dissections are procedure related. In contrast to the MOTHER (Medtronic Thoracic Endovascular Registry) database, 8 which showed that 50% of RTAD occurs after the 30th day after surgery, we did not identify any cases during the follow-up period. The potential factors that predispose patients to RTAD after TEVAR may be classified as procedure related, device related, and aorta related (from aortic wall fragility and aortic morphology).…”

Management beim akuten Aortensyndrom

“…Daten des IRAD-Registers zeigen bessere Überle-bensraten von interventionell versorgten komplizierten Typ-B-Aortendissektionen als bei Patienten, die einer offenen operativen Versorgung zugeführt wurden [44]. Auch bei unkomplizierten Typ-B-Dissektionen, die historisch eher konservativ therapiert wurden, zeigen neueste Daten, dass eine präventive Stentgraftimplantation einen positiven Effekt auf die Komplikationsrate und die 5-Jahres-Überlebens-wahrscheinlichkeit hat [45,46]. Aufgrund der geschilderten Datenlage ist es wahrscheinlich, dass die interventionelle endovaskuläre Stentgraftimplantation eine Indikationserweiterung erfahren wird und sich möglicherweise zum Goldstandard bei anatomisch vertretbaren thorakalen oder thorakoabdominellen Dissektionen entwickeln wird (.…”

Open aortic surgery after thoracic endovascular aortic repair

“…& Joseph S. Coselli jcoselli@bcm.edu degenerative aneurysms [4][5][6], 16 to 24 % when used for chronic type B aortic dissections [4][5][6][7][8], and 21 to 32 % when used for acute type B dissections [5,6,9,10]. In addition, a lack of operator experience likely plays a role in the development of postoperative complications after TEVAR.…”

“…Although it is difficult to assess the rate of open repair after TEVAR, the rates in large series of TEVAR cases ([300) have ranged from 0.4 to 7.9 % [4,6]. Major complications of TEVAR that typically necessitates open distal aortic repair (i.e., repair of the descending thoracic or thoracoabdominal aorta) include endoleak (especially type I), aortic fistula, infection, device collapse or migration, and continued expansion of the aneurysm sac.…”