The Valiant thoracic endograft

Thoracic aortic pathology is common, but conventional surgery carries with it a significant risk of mortality and morbidity due to thoracotomy, extensive surgical dissection, partial left lung collapse, proximal aortic cross-clamping and blood loss necessary for open thoracic aortic replacement. Endovascular techniques have the potential to remove much of this harm. However, endograft delivery to the thoracic aorta brings its own challenges; the graft and delivery system must be conformable to follow the aortic arch, flexible to track through tortuous calcified vessels, of low profile for access through the iliac arteries, and deploy accurately and with minimal force to avoid accidental side branch occlusion. The endoprosthesis must also prove to be durable. This paper reviews current indications for thoracic aortic stent grafts and the properties of an ideal endograft for deployment in the arch and descending aorta. The Medtronic Valiant TM endoprosthesis with Xcelerant TM Delivery System is a third-generation system designed specifically for the treatment of a range of thoracic aortic pathologies, including but not exclusively, aneurysms and dissections. The design of the Valiant endoprosthesis and delivery system are described in detail, and compared to the second-generation Talent system. Our early experience of using Valiant in 28 patients with a range of pathologies is described. The graft achieved an initial technical success in 93% and was easy to position and deploy. Long-term data is now required; the Virtue Registry is a prospective multicenter European registry collecting clinical and health economics data on Valiant in the management of aortic dissections.