Endovascular stent-graft treatment of aortic dissection: Determinants of post-interventional outcome

Abstract

Aims: To investigate the results of endovascular stent-graft placement for the treatment of patients with type B aortic dissection (B-AD). Methods and results: A total of 38 patients (62 ± 10 years, 32 male) with acute (n = 10) and chronic (n = 28) type B-AD were treated with endovascular stent-grafts. The implantation procedure was successful in all patients. Peri-procedural non-fatal complications occurred in four (11%) patients. Overall, 4/38 (11%) patients died during the in-hospital period. Patients undergoing stent-graft placement for acute AD had a significantly higher in-hospital mortality than patients with chronic AD (40 vs. 0%, P = 0.001). During a median follow-up of 18 (1-57) months, there were six additional deaths. Overall survival rates were 97.4 ± 2.6% at 30 days, 80.4 ± 6.7% at 1 year, 73.2 ± 7.8% at 2 years, and 54.9 ± 16.9% at 4 years. Patients with a poor clinical health status (ASA class > 3) had a significantly reduced life expectancy compared with patients with only moderate co-morbidities (ASA class ≤ 3) (1-year survival rate 28.6 ± 17.1 vs. 92.6 ± 6.7%, P = 0.0001). Multivariable analysis revealed that a poor clinical health status (ASA > 3) pre-operatively (HR = 29.5, 95% CI 1.5-581.9, P = 0.026) and increased age (HR = 1.1, 95% CI 0.9-1.2, P = 0.084) were independent determinants of post-interventional mortality. Conclusion: Endovascular stent-graft treatment is a safe alternative for patients with AD. The pre-operative clinical health status of the patient is the most important determinant of post-interventional outcome. Careful patient selection is thus of particular importance. © The European Society of Cardiology 2005. All rights reserve.