Endovascular Therapy in Patients with Ruptured Thoracic Aortic Diseases: Results from the GREAT Registry
David J. O'Connor, MD1, Fred Weaver, MD2, Santi Trimarchi, MD3, Michael Wilderman, MD1, Anjali Ratnathicam, DO1, Kristen Cook, MD1, Massimo Napolitano, MD1, Gregory Simonian, MD1.
1Hackensack University Medical Center, Hackensack, NJ, USA, 2University Southern California, Los Angeles, CA, USA, 3University of Milan, Milan, Italy.
Objectives: The Global Registry for Endovascular Aortic Treatment (GREAT) is a prospective observational multicenter cohort registry of all Gore aortic endografts for a variety of aortic pathologies. The purpose of this study is to evaluate the outcome of the Conformable GORE® TAG® Thoracic Endoprosthesis (CTAG) and GORE® TAG® Thoracic Endoprosthesis (TAG) devices for ruptured thoracic aortic syndromes.
Methods: Between December 2010 and October 2016 a total of 5018 patients were enrolled from 114 sites in this registry. The database was queried for patients with at least one of the following pathologies: descending thoracic aortic aneurysm with rupture, thoracoabdominal aortic aneurysm rupture, descending aortic dissection rupture, and aortic arch aneurysm rupture. Patient demographics, operative details, and clinical outcomes were analyzed.
Results: A total of 39 patients were treated with a ruptured thoracic aortic disease (61.5% male, mean age 68.3 ± 13.5 years). Nineteen patients were treated for descending thoracic aneurysm rupture, 9 for thoracoabdominal aneurysm rupture, 7 for descending aortic dissection rupture, and 4 for aortic arch aneurysm rupture. There were no conversions to an open procedure. A total of 11 patients (28.2%) required involvement of at least one aortic branch vessel (4 covered, 5 surgically de-branched, 1 stented, 5 Chimney technique).
Thirty-day mortality was 4 (10.3%) patients. Early reintervention (≤ 30 days) was required in 6 (15.3%) patients. There were a total of 4 endoleaks through 2 year follow-up, with 3 needing a reintervention. Mean follow-up duration was 13.95 ± 2.94 months (range 0-24 months). There were no late aortic ruptures or conversion to open repair. Freedom from device-related intervention at 1 year was 91.5% (95% CI 75.9-97.2%) and 2 year 82.4% (95% CI 53.0-94.2%). Freedom from all-cause mortality at 1 year was 70.2% (95% CI 49.8-83.6%) and at 2 years 64.3% (95% CI 42.3-79.8%).
Conclusions: CTAG and TAG thoracic endografts provide an effective treatment for ruptured thoracic aortic diseases. Adjunctive coverage or revascularization of an aortic branch vessel may be necessary. This cohort of patients is planned to have ten years of follow-up. Larger studies with long follow-up are needed to determine the durability of these repairs.
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