Evolving experience with thoracic aortic stent graft repair.

Area of Science:

• Cardiovascular Surgery
• Interventional Radiology

Background:

• Thoracic aorta (TA) diseases encompass a range of conditions including aneurysms, dissections, and intramural hematomas.
• Open surgical repair of TA pathologies can be associated with significant morbidity and mortality, particularly in patients with comorbidities.

Purpose of the Study:

• To evaluate the initial experience with thoracic aorta (TA) stent grafting in 28 patients.
• To compare the outcomes of homemade stent grafts (Dacron over Gianturco Z stents) with a commercial device (Excluder).

Main Methods:

• A retrospective review of 28 patients undergoing TA stent grafting between November 1996 and August 2001.
• Patients presented with diverse TA pathologies, including degenerative aneurysms, chronic dissections, and pseudoaneurysms.
• The study compared 14 patients treated with homemade devices and 14 with a commercial device, noting patient demographics, comorbidities, and procedural details.

Main Results:

• The procedural mortality rate was 3.5% (1/28), with one additional device-related death during follow-up (mean 17 months).
• Access artery complications occurred in 21% of patients, with one fatality. Complete exclusion of TA lesions was achieved in 96% of cases.
• Commercial devices demonstrated superior ease and accuracy of deployment compared to homemade devices. No spinal cord ischemia was noted.

Conclusions:

• Thoracic aorta (TA) stent graft repair is a safe and effective alternative for managing a spectrum of TA diseases.
• Further prospective trials are needed to define the specific role of TA stent grafting for individual pathologies.