Bartoli Stephan Kische, Virginia Gaxotte, Marc Schepens, Marek Ehrlich and Jean-Michelle
Heijmen, Martin Grabenwöger, Philippe Piquet, Luigi Lovato, Chaouki Dabbech, Rossella Fattori, Christoph A. Nienaber, Hervé Rousseau, Jean-Paul Beregi, Robin
stent graft: The Talent Thoracic Retrospective RegistryResults of endovascular repair of the thoracic aorta with the Talent Thoracic
http://jtcs.ctsnetjournals.org/cgi/content/full/132/2/332located on the World Wide Web at:
The online version of this article, along with updated information and services, is
esults of endovascular repair of the thoracic aorta withhe Talent Thoracic stent graft: The Talent Thoracicetrospective Registry
ossella Fattori, MD,a Christoph A. Nienaber, MD,b Hervé Rousseau, MD,c Jean-Paul Beregi, MD,d Robin Heijmen, MD,e
artin Grabenwöger, MD,f Philippe Piquet, MD,g Luigi Lovato, MD,a Chaouki Dabbech, MD,c Stephan Kische, MD,b
irginia Gaxotte, MD,d Marc Schepens, MD,e Marek Ehrlich, MD,f and Jean-Michelle Bartoli, MDh
Bprpia
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Cardiovascular Radiology, University Hos-pital S. Orsola, Bologna, Italya; Division ofCardiology, University Hospital Rostock,Rostock, Germanyb; Department of Radiol-ogy, Centre Hospitalier Universitaire,Hôpital de Rangueil, Toulouse, Francec;Radiologie Vasculaire, Hôpital Cari-ologique CHRU de Lille, Lille, Franced;Department of Cardiothoracic Surgery, St.Antonius Hospital, Nieuwegein, The Nether-landse; Department of Cardio-Thoracic Sur-gery, University of Vienna, Vienna, Aus-triaf; Department of Vascular Surgery,Centre Hospitalier Universitaire, HôpitalSainte Marguerite, Marseille, Franceg; andDepartment of Interventional Radiology,Centre Hospitalier Universitaire, Hôpital dela Timone, Marseille, France.h
This is a company registry study of theMedtronic Talent Thoracic stent graft. Au-thors Rossella Fattori, Christoph A. Niena-ber, Hervé Rousseau, Jean-Paul Beregi, andRobin Heijmen each report receiving con-sulting and/or lecture fees from Medtronic.
Received for publication Dec 26, 2005; re-visions received Feb 21, 2006; accepted forpublication March 15, 2006.
Address for reprints: Rossella Fattori, De-partment of Radiology–Cardiovascular Unit(pad 21), University Hospital S.Orsola, ViaMassarenti 9, 40128 Bologna, Italy (E-mail:[email protected]).
ackground: Endovascular treatment of thoracic aortic diseases demonstrated lowerioperative morbidity and mortality when compared with conventional openepair. Long-term effectiveness of this minimally invasive technique remains to beroven. The Talent Thoracic Retrospective Registry was designed to evaluate thempact of this therapy on patients treated in 7 major European referral centers overn 8-year period.
ethods: Data from 457 consecutive patients (113 emergency and 344 electiveases) who underwent endovascular thoracic aortic repair with the Medtronic Talenthoracic stent graft (Medtronic/AVE, Santa Rosa, Calif) were collected. Follow-upnalysis (24 � 19.4 months, range 1-85.1 months) was based on clinical andmaging findings, including all adverse events. To ensure consistency of datanterpretation and event reporting, one physician reviewed all adverse events andeaths for the whole cohort of patients. In the case of discrepancies, the treatinghysicians were queried.
indings: Among 422 patients who survived the interventional procedure (in-ospital mortality 5%, 23 patients), mortality during follow-up was 8.5% (36atients), and in 11 of them the death was related to the aortic disease. Persistentndoleak was reported at imaging follow-up in 64 cases: 44 were primary (9.6%)nd 21 occurred during follow-up (4.9%). Seven patients with persistent endoleakad aortic rupture during follow-up, at a variable time from 40 days to 35 months,nd all subsequently died. A minor incidence of migration of the stent graft (7ases), graft fabric alteration (2 cases), and modular disconnection (3 cases) wasbserved at imaging. Kaplan-Meier overall survival estimate at 1 year was 90.97%,t 3 years was 85.36%, and at 5 years was 77.49%. At the same intervals, freedomrom a second procedure (either open conversion or endovascular) was 92.45%,1.3%, and 70.0%, respectively.
onclusion: Endovascular treatment for thoracic aortic disease with the Talent stentraft is associated with low early morbidity and mortality rates also for patients whore at high risk and treated on an emergency basis. Follow-up data indicate aubstantial durability of the procedure with a high freedom from related death andecondary interventions.
he natural history of degenerative thoracic aortic disease is progressive andmay lead to dilation, dissection, and rupture. Aggressive medical treatmentand careful imaging follow-up contributed to improve survival of patients
ith thoracic aortic diseases. However, medical therapy alone can only delay, butot avoid, aneurysm expansion and rupture: reported 5-year mortality is 16% for
neurysms smaller than 6 cm in diameter and 31% for aneurysms larger than 6 cm
vascular Surgery ● August 2006 on June 4, 2013 jtcs.ctsnetjournals.orgloaded from
n diameter.1-3 Therefore, preventive surgical resection hasong been considered the only treatment strategy, althoughssociated with significant mortality and morbidity.4-9
The advent of endovascular techniques revolutionizedhe management of thoracic aortic disease, enabling low-nvasive repair even in high-risk patients unfit for openurgery. Compared with open surgery, stent-graft treatments associated with decreased perioperative mortality ratesnd fewer complications, even in older patients with signif-cant comorbidities.10-23 However, data on midterm andong-term follow-up are limited. The Talent Thoracic Ret-ospective Registry (TTR) was designed to collect outcomeata from patients who underwent endoluminal treatmentith the Medtronic Talent thoracic stent graft (Medtronic/VE, Santa Rosa, Calif) in 7 European referral centers. Data
ollection was focused on clinical and imaging follow-upith particular reference to mortality and long-term com-lications.
ethodsnrolmenthe entire cohort study consisted of 457 consecutive patients whonderwent endovascular thoracic aortic repair with the Talenthoracic stent graft between November 1996 and March 2004.even European referral centers (Bologna, Toulouse, Rostock, Lille,ienna, Nieuwegein, and Marseille) provided data from patients
reated consecutively, with a minimum of 1-month follow-up. Thethical committee of each institute approved the study. Baselineemographic and clinical characteristics are listed in Table 1,ncluding information on comorbidities, American Society ofnesthesiologists (ASA) class, previous cardiac or aortic surgery,
neurysm/dissection anatomy, and operative and postoperativeourses. Follow-up analysis was formed on clinical and imagingndings until the last visit date, including all adverse events.ostoperative imaging findings were focused to any evidence ofxpansion of aneurysm size or graft-related problems, such asinking, migration, modular disconnection, or integrity of the graftabric. Data were collected on case report forms and entered in twoeparate databases by a data collection specialist and by the leaduthor (R.F.; Maastricht, The Netherlands, and Bologna, Italy).ase report forms were all reviewed by the lead author andhecked for inconsistencies. In case of discrepancies, the partici-ating investigator at each site was queried to ensure appropriatenterpretation of events. The two different databases were thenompared and errors in data entries were corrected by checking on
Abbreviations and AcronymsASA� American Society of AnesthesiologistsCI � confidence intervalCT � computed tomographyMRI � magnetic resonance imagingOR � odds ratioTTR � Talent Thoracic Retrospective Registry
he specific case report form. r
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atient Characteristicshe registry comprises 350 male and 107 female patients with aean age of 59.6 years, ranging from 19 to 91 years (Table 1). The
pectrum of thoracic aortic diseases comprised 180 (39.4%) tho-acic aortic dissections, 137 (29.9%) atherosclerotic aneurysms, 143%) pseudoaneurysms, 29 (6.3%) penetrating ulcers, 12 (2.6%)ntramural hematomas, and 85 (18%) posttraumatic aneurysmsTable 1). Two hundred fifty-six (56%) patients were classified asSA class III/IV/V. Previous cardiac or aortic surgery was re-orted on 21 (4.6%) and 103 (22.5%) patients, respectively, while(1.1%) patients had already received endovascular therapy for
bdominal aortic aneurysm. Mean aortic diameter for the aorticissection and atherosclerotic aneurysms was 60.1 � 16.7 (range:6-136 mm) (Table 2).
maging Evaluationefore treatment all patients were examined by at least one tomo-raphic imaging modality, such as computed tomography (CT) andagnetic resonance imaging (MRI), in addition to angiography or
ransesophageal echocardiography. Information on maximum an-urysm diameter or on dissection size, proximal and distal ana-omic extension, and distance from the left subclavian artery were
ABLE 1. Demographics and clinical characteristics ofatients (n � 457)
No. %
ale 350 76.6ge, y (mean � SD) 59.6 � 16SA class (�III) 256 56revious aortic surgery 103 22.5revious cardiac surgery 21 4.6ypertension 331 72.4enal insufficiency 72 15.7OPD 102 22.3iabetes 48 10.5VA 33 7.2arfan syndrome 15 3.2
22%) or angiography combined with MRI (15%) was the mostrequently used imaging method. Imaging follow-up was assessedccording to the set protocol of each center, generally consisting of0 days to 6 months and yearly CT or MRI: CT was performed in5% and MRI in 21% of cases. A chest x-ray film was alsobtained in 21% of patients. Information regarding aneurysmxpansion or reduction in size, endoleak, aneurysm sac/false lu-en thrombosis, and stent-graft material alteration were collected.
evice Descriptionhe Talent Thoracic stent graft is composed of a Dacron graftaterial supported by self-expanding nitinol springs. The springs
re sewn to the graft material with polyester sutures. The graftaterial is a sheet of monofilament polyester with a seam joining
he edges to create a cylindrical tube. Opposite the seam is theonnecting bar, which attaches the most proximal and distalprings. The connecting bar provides columnar strength to theevice and facilitates deployment. During implantation, the con-ecting bar should be oriented to the outer radius for stent-graftonformability and kink resistance. All nitinol components are
ABLE 2. Procedural details and early results (457 patients)No. %
eneral anesthesia 453 99.1aximum diameter (dissection and
atherosclerotic aneurysms),mm (mean � SD)
30760.1 � 16.7
ength of covered aorta, mm (mean � SD) 131.5 � 44.1tent-graft segment used
One 312 68.3Two 94 20.6Three 35 7.6More than three 5 1.1
D, Standard deviation; LSA, left subclavian artery.
urface treated to enhance long-term fatigue performance. The T
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alent stent graft system has many modular sections that can besed to treat a wide variety of thoracic lesions. The stent graft hashree proximal and distal configurations. The proximal configura-ions are FreeFlo, Bare Spring (22 mm only), and Open Web,hich all have a flared geometry. The FreeFlo design (different
rom the Bare Spring configuration) has a bare spring and aini-support spring, which improves sealing for sizes 24 to 46m. The distal configurations are Bare Spring, Closed Web, andpen Web. The Open Web configuration was designed for use asistal extensions for the Talent stent-graft system.
nterventional Endovascular Procedureeneral anesthesia was used for the endovascular aortic procedure
n 453 of 457 patients. One hundred thirteen (27.4%) patients werereated under emergency conditions and 344 (75.3%) patients werereated electively. The mean length of covered aorta was 131.5m, ranging from 28 to 380 mm with one stent used in 70% of
ases. The stent graft was positioned in the proximal descendingortic segment in 124 patients (neck length � 1 cm). In 54 patientshe stent graft was positioned in the distal aortic arch with cover-ge of the left subclavian artery to extend the proximal landingone. In 40.7% of them (22 patients) revascularization of the leftubclavian artery was performed before stent-graft treatment.
tatistical Analysisncidence rates of events are reported by giving the number ofatients experiencing the event followed by the correspondingercentage. Continuous data are reported by giving the mean �tandard deviation and/or median and the range of values ob-erved. Where incidence rates (or proportions) were statisticallyompared between groups, the �2 test or Fisher exact test wassed. Stepwise logistic regression analysis was performed to de-ermine predictors of in-hospital death and in-hospital complica-ions (stroke, paraplegia, extension of dissection, vascular local,enal, cardiac, pulmonary). Noncorrelated variables with P � .05t univariate analyses were included in the multivariate models;odel precision was evaluated by the Hosmer-Lemeshow goodness-
f-fit statistic. Estimates of times to events and the accompanyingurves were generated by the method of Kaplan and Meier. Sta-istical analyses were carried out with SPSS software packageersion 13.0 (SPSS, Inc, Chicago, Ill).
esultsrocedural Technical Failureechnical failure, for example, failure to complete an
ntended stent-graft deployment, occurred in 10 (2.2%)atients owing to inadequate caliber of the femoral orliac artery (failure of graft insertion, 7 cases) or difficulteployment (3 cases). Immediate conversion to open repairas documented in 3 (0.7%) cases. Perioperative endoleakas visualized at the end of the procedure in 98 patients
Table 3). However, 26 endoleaks sealed spontaneouslyuring follow-up, whereas an adjunctive endovascular treat-ent with insertion of a graft extension allowed endoleak
esolution in 18. Ten cases of primary endoleak leading toneurysm expansion were converted to open surgical repair.
herefore, the rate of persistent primary endoleak was 9.6%
44 patients). Endoleak type I was the most common7.7%), whereas the incidence of type III (0.7%) and type II1.5%) was very low.
n-hospital Mortalityhe length of hospital stay was 12.8 days (range 1-149) with aedian of 9 days. Twenty-three patients died, an in-hospital
within 30 days of the procedure or within the same hospital-zation as the primary procedure) mortality of 7.9% for acutend 4% for elective cases (P � .16). Two of 23 (0.4%) patientsied during the endovascular procedure of aortic rupture; bothere emergency cases of type B aortic dissection. Multivariate
ogistic regression analysis showed that age of 75 years orlder (odds ratio [OR] 2.49; 95% confidence interval [CI].02-6.43; P � .048) and ASA class IV or V (OR 3.0; 95% CI.20-7.47; P � .018) were independent predictors of in-hos-ital mortality (94.3% of correct classification, Hosmer-Leme-how goodness-of-fit P � .770) (Table 3). Traumatic aorticnjury could not be used in this model because there were non-hospital deaths in the modeled trauma population. Univar-
ABLE 3. Predictors of in-hospital death and in-hospitalomplications (logistic regression analysis*)
Univariateanalysis P
Multivariateanalysis
OR (95% CI) P
n-hospital deathASA class (�IV) .01 3.00 (1.20-7.47) .018Experience (�2000 y) .09Age (�75 y) .03 2.49 (1.02-6.43) .048Male .88Patient status (acute) .11Traumatic aortic injury .03Aortic aneurysm .16Dissection .66Penetrating ulcer and
R, Odds ratio; CI, confidence interval; ASA, American Society ofnesthesiologists. *Only variables with P � .05 at the univariate analysisere entered into the multivariate analysis.
ate analysis showed that traumatic aortic injury had a statisti- m
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ally significantly lower risk of in-hospital death than othertiologies (P � .03) (Table 3).
n-hospital Complicationsajor adverse events are listed in Table 2. The most com-on were cerebral vascular accidents and vascular trauma
uring the procedure. Multivariate logistic regressionnalysis showed that acute status (OR 2.8; 95% CI 1.5-5.2;� .001) and ASA class IV or V (OR 2.3; 95% CI 1.2-4.4;� .016) were independent predictors of in-hospital com-
lications, whereas traumatic aortic injury was signifi-antly associated to lower rate of complications (OR 0.3;5% CI 0.1-0.8; P �.016) (86.3% of correct classification,osmer-Lemeshow goodness-of-fit P � .711) (Table 3).troke occurred in 17 patients and was significantly asso-iated to occlusion of the left subclavian artery withoutrevious revascularization (P � .004, Fisher exact test).araplegia (3 patients) and paraparesis (5 patients) occurred
n 8 cases (4 degenerative aneurysm and 4 type B dissec-ion) and was significantly associated to length of coveredorta greater than 20 cm (P � .001, Fisher exact text). Atollow-up, the spinal ischemic damage was persistent in the
cases of paraplegia, whereas paraparesis resolved com-letely in 4 of 5 patients.
ortality and Aortic Rupture at Follow-uplinical and imaging mean follow-up was 24 � 19.4
ABLE 4. Follow-up data (422 patients)No. %
ortalityOverall 36 8.5Death related to aneurysm/dissection 11 2.6
ailure of procedureAortic rupture 7 1.6Conversion to surgery 3 0.7Persistent secondary endoleak 21 4.9
years of clinical and imaging follow-up available, includ-ng 23 with over 5 years of follow-up. Late mortality was.5% (36 patients), and in 11 of them death was related tohe aorta: 7 cases of aortic rupture at a variable time from 40ays to 35 months, 2 extentions of dissection, and 2 aortoe-ophageal fistulas (Figure 1). Other cause of death includedyocardial infarction, respiratory insufficiency, cerebrovas-
ular accident, and neoplasm. In 5 patients the cause ofeath was not specified in the case report form. All 7atients who had an aortic rupture during follow-up subse-uently died. Among them, 6 had aortic dissection as pri-ary disease and all 7 patients had type I persistent primary
r secondary endoleak, with aneurysm expansion at imag-ng follow-up (Figure 2).
econdary Endoleakecondary endoleak (types I and III) was reported in 4410.4%) patients. Endovascular adjunctive treatment al-
igure 1. In-hospital and follow-up mortality (overall death andeath related to stent-graft procedure).
igure 2. Early and long-term rate of aortic rupture in patients
yith and without endoleak (log-rank test P < .0001).
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owed successful sealing in 19 of these patients; one case ofpontaneous resolution was recorded, while in 3 additionalatients conversion to open repair was necessary (Figure 3).wenty-one (4.9%) patients did not undergo treatment forecondary endoleak.
tent-graft Complicationsigration (reported as millimeters of distance of the prox-
mal covered part of the stent graft from the left subclavianrtery both at the implant and during follow-up) greater thanmm was observed in 7 patients (median 10 mm, range
-40 mm). A type I endoleak was present in 2 of them.isconnection among stent-graft segments was visualized at
maging follow-up in 6 patients, leading to secondary en-oleak type III in 4 patients.
Alteration of the graft material was identified in 2 pa-ients. One patient had an aortoesophageal fistula 2 yearsfter successful endovascular treatment of an atheroscleroticneurysm. On CT scan, a detachment of the distal nitinolrame was noted, facing the esophageal erosion. Anotherase of proximal detachment of one nitinol frame had nolinical consequences.
hange in Aneurysm Dimensionhe dynamics of aneurysm dimension are summarized inable 4. Thirteen of 22 patients with endoleak type I
among patients in which this information was reported),ither primary or secondary, showed an increase of theneurysm sac (medium 9 mm, ranging from 5 to 80 mm).
ong-term Survivalaplan-Meier overall survival estimate at 1 year was 90.1%, atyears was 84.6%, and at 5 years was 74.1%. Kaplan-Meier
stimate for freedom from related death was 96.0% at 1
igure 3. Freedom from second procedure (defined as conversiono surgery or second endovascular treatment) in hospital anduring follow-up.
ear, 93.9% at 3 years, and 90.2% at 5 years. At the same
nterval, freedom from a second procedure (either openonversion or endovascular) was 92.4%, 81.3%, and 70.0%,espectively (Figure 3).
iscussionndovascular treatment of descending thoracic aortic dis-ases is a recent advance among interventional techniques,eceiving increasing attention as a nonsurgical alternative topen repair. More notably than in abdominal aortic aneu-ysm, in which endovascular techniques compare with aower risk surgery, stent-graft repair for thoracic aorticiseases is able to offer a therapeutic option even to high-isk patients unfit for open surgery. The feasibility of endo-ascular treatment in thoracic aortic diseases was first re-orted by Dake and associates10 in 1994, using a homemadeitinol-Dacron stent graft in 103 patients. In 1997, commer-ially manufactured stent grafts enabled increasing use androwth of technical skill and knowledge in many cen-ers.11-20 Experience with endovascular treatment in a widepectrum of aortic diseases demonstrates the feasibility of thispproach even in unstable patients with encouraging earlynd midterm results.21-23 However, long-term follow-up ofhe first thoracic homemade device is discouraging24 andssociated with low survival. Accordingly, experience withndovascular treatment of abdominal aortic diseases25,26
timulated the need for long-term outcome data and efficacyf the stent graft in aortic diseases. The present experienceas some limitations: Data were retrospectively collected,ith no control over the inclusion criteria for the endovas-
ular procedure. The lack of a randomized or concurrentontrol patient group precluded direct comparison with con-entional open surgical repair. In addition, the absence ofutopsy confirmation in deceased patients does not allow inll cases exclusion of aortic rupture as a possible cause ofeath.
Yet, this is the first study on long-term results in a wideohort of patients (457) over an 8-year period, with morehan 3 years of clinical and imaging follow-up available in5 patients. Early results are comparable with other reportedase series: in-hospital mortality was 5%, comprising 113atients treated under emergency condition. An advantagef endovascular repair in acute aortic syndrome is itsotential to reduce blood loss27,28 with respect to openurgery, in which back-bleeding from branch arteries andnastomotic sites or from iatrogenic venous injuries couldrecipitate shock and neurologic consequences. Most peri-perative complications in emergency endovascular casesf this study arose from preexisting medical conditions andere not procedure related. This study showed that in pa-
ients with traumatic aortic rupture (85 patients with no mor-ality), endovascular stent-graft treatment strongly abatedhe high mortality of conventional open surgical repair.29 In
atients with complex multiple trauma, the possibility of a
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ow-invasive treatment of the aortic lesion may allow arompt management of the other associated lesions, withimited impact on trauma destabilization and improvedverall survival. The feasibility of endovascular treatmentn patients with Marfan syndrome is controversial, becausef the particular fragility of the aortic wall. No significantifferences in results and outcome emerged from data anal-sis of the 15 Marfan patients with type B dissection in-luded in this registry. However, no definite results could berawn from such a limited number of cases.
The present study showed that the most frequent com-lications in endovascular procedure are stroke (3.7%) andascular lesions at the access site (3.2%), both probablyelated to the difficult advancement and manipulation of theheath, which still has a large outer diameter (22F-27F) andelative inflexibility. New developments of stent-graft ma-erial and design might reduce these problems. Amongeveral variables examined, the only significant predictor oftroke was the occlusion of the left subclavian artery with-ut previous revascularization. With regard to intentionaleft subclavian artery occlusion the available data are con-icting; although recent endovascular reports30 suggest aelative safety if some precautions are met, surgical expe-ience with deliberate ligation of the vertebral artery31 leadso a 5.4% rate of ischemic complications.
Spinal cord ischemia with resultant paraplegia is of sig-ificant concern with open surgery of descending thoracicortic aneurysms,32 while the endovascular stent graft holdshe potential for reducing the risk, avoiding crossclamping,ignificant blood loss, and severe hypotension. However,xperience with endovascular treatment does not allow us todentify the anatomic and clinical characteristics for spinalord ischemia. Concomitant or previous abdominal aneu-ysm repair has been reported as a risk factor.26,33 In ouregistry, paraplegia occurred in only 3 patients and it oc-urred in patients without previous abdominal aortic sur-ery. Long-segment thoracic aortic exclusion was the mostmportant predictor of spinal ischemia, both for patientsith dissection and for those with aneurysm.Long-term survival is one of the major concerns in
atients with severe comorbidities: 56% of this populationad an ASA class of III or more. In this cohort of high-riskatients, Kaplan-Meier curves at 36 months indicate a sur-ival of 84.6% (Figure 1), with a low incidence of aorta-elated deaths (9%) and secondary procedures, both surgicalnd interventional (11%). Long-term results confirm thatndoleak is the most important risk for aortic rupture. Allatients with aortic rupture during the follow-up had type Iersistent endoleak. According to the literature,34-37 type IIndoleak, due to reperfusion of the aneurysm sac by inter-ostal arteries, is relatively uncommon (0.5% primary and.8% secondary endoleak) and does not seem to constitute
risk factor for aortic rupture. Migration has not been
and Cardiovascular Surgery ● Volume 132, Number 2 337 on June 4, 2013 urnals.org
nvestigated previously in thoracic endografting.38,39 In-eed, all previous case series and registries have a maxi-um of 1-year follow-up or a limited number of patients for
onger periods. However, migration seems uncommon inhis setting, even several years after implant. In the presenteries, migration was assessed by reporting differences inhe distance of the proximal covered part of the stent graftrom the left subclavian artery between the postoperativend subsequent imaging; it occurred in only 7 patients.lthough the cases are few, migration was potentially
aused by inadequate oversizing or disease progressionroximally or distally, resulting in slow enlargement of theanding zones and subsequent loss of fixation. A majoroncern in endovascular treatment is the durability of theraft material, especially in the case of young patients.abric deterioration has been reported with almost all de-ices in abdominal series and also with thoracic stent grafts.ith first-generation endovascular grafts using wire-formed
itinol, electrochemical corrosion leading to stent fractureas been reported, even after a short period of implanta-ion.24 Nitinol possesses a high elasticity and very goodiocompatibility, and it is known to have good resistance toorrosion, depending on the processing techniques and theuality of the protective titanium oxide surface layer. Im-rovements in the manufacturing process have led to betteruality material and improved the surface finish. Laserutting, polishing, and heat treatment procedures have en-anced nitinol’s corrosion resistance. Our data seem toonfirm the durability of the material, with 2 cases in aohort of 422 patients, some of whom have the stent graft initu for more than 8 years.
In conclusion, endovascular treatment for thoracic aorticisease with the Talent stent graft carried out at high-olume referral centers is associated with low early mor-idity and mortality rates also for patients at high risk andreated on an emergency basis. Follow-up data indicate aubstantial durability of the procedure with a high freedomrom related death and secondary interventions. Long-termurveillance will be crucial to discover complications uniqueo thoracic endovascular interventions and to determinehich patients are appropriate candidates for stent-graft
herapy.
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and Cardiovascular Surgery ● Volume 132, Number 2 339 on June 4, 2013 urnals.org
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stent graft: The Talent Thoracic Retrospective RegistryResults of endovascular repair of the thoracic aorta with the Talent Thoracic
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