Thompson Matt, Ivaz Stella, Cheshire Nicholas, Fattori Rosella, Rousseau Herve, Heijmen Robin, Beregi Jean-Paul, Thony Frederic, Horne Gillian, Morgan Robert, Loftus Ian
St George's Vascular Institute, 4th Floor St James Wing, St George's Hospital NHS Trust, Blackshaw Road, London SW17 0QT, UK.
Cardiovasc Intervent Radiol. 2007 Nov-Dec;30(6):1130-8. doi: 10.1007/s00270-007-9147-x. Epub 2007 Aug 21.
Endovascular repair of the thoracic aorta has been adopted as the first-line therapy for much pathology. Initial results from the early-generation endografts have highlighted the potential of this technique. Newer-generation endografts have now been introduced into clinical practice and careful assessment of their performance should be mandatory. This study describes the initial experience with the Valiant endograft and makes comparisons with similar series documenting previous-generation endografts. Data were retrospectively collected on 180 patients treated with the Valiant endograft at seven European centers between March 2005 and October 2006. The patient cohort consisted of 66 patients with thoracic aneurysms, 22 with thoracoabdominal aneurysms, 19 with an acute aortic syndrome, 52 with aneurysmal degeneration of a chronic dissection, and 21 patients with traumatic aortic transection. The overall 30-day mortality for the series was 7.2%, with a stroke rate of 3.8% and a paraplegia rate of 3.3%. Subgroup analysis demonstrated that mortality differed significantly between different indications; thoracic aneurysms (6.1%), thoracoabdominal aneurysms (27.3%), acute aortic syndrome (10.5%), chronic dissections (1.9%), and acute transections (0%). Adjunctive surgical procedures were required in 63 patients, and 51% of patients had grafts deployed proximal to the left subclavian artery. Comparison with a series of earlier-generation grafts demonstrated a significant increase in complexity of procedure as assessed by graft implantation site, number of grafts and patient comorbidity. The data demonstrate acceptable results for a new-generation endograft in series of patients with diverse thoracic aortic pathology. Comparison of clinical outcomes between different endografts poses considerable challenges due to differing case complexity.
胸主动脉腔内修复术已被用作多种病变的一线治疗方法。早期一代腔内移植物的初步结果凸显了该技术的潜力。新一代腔内移植物现已引入临床实践，对其性能进行仔细评估应是必不可少的。本研究描述了使用Valiant腔内移植物的初步经验，并与记录前代腔内移植物的类似系列进行比较。回顾性收集了2005年3月至2006年10月期间在欧洲七个中心接受Valiant腔内移植物治疗的180例患者的数据。患者队列包括66例胸主动脉瘤患者、22例胸腹主动脉瘤患者、19例急性主动脉综合征患者、52例慢性夹层动脉瘤样退变患者和21例创伤性主动脉横断患者。该系列的总体30天死亡率为7.2%，卒中率为3.8%，截瘫率为3.3%。亚组分析表明，不同适应证之间的死亡率差异显著；胸主动脉瘤（6.1%）、胸腹主动脉瘤（27.3%）、急性主动脉综合征（10.5%）、慢性夹层（1.9%）和急性横断（0%）。63例患者需要辅助手术，51%的患者在左锁骨下动脉近端植入移植物。与一系列早期一代移植物相比，根据移植物植入部位、移植物数量和患者合并症评估，手术复杂性显著增加。数据表明，新一代腔内移植物在一系列患有不同胸主动脉病变的患者中取得了可接受的结果。由于病例复杂性不同，比较不同腔内移植物的临床结果面临相当大的挑战。
