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European Heart Journal Advance Access originally published online on January 26, 2005
European Heart Journal 2005 26(5):489-497; doi:10.1093/eurheartj/ehi099
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© The European Society of Cardiology 2005. All rights reserved. For Permissions, please e-mail: journals.permissions{at}oupjournals.org

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

Holger Eggebrecht1,*, Ulf Herold2, Oliver Kuhnt1, Axel Schmermund1, Thomas Bartel1, Stefan Martini1, Alexander Lind1, Christoph K. Naber1, Peter Kienbaum3, Hilmar Kühl4, Jürgen Peters3, Heinz Jakob2, Raimund Erbel1 and Dietrich Baumgart1

1Department of Cardiology, West-German Heart Centre Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany
2Department of Cardio-thoracic Surgery, West-German Heart Centre Essen, University of Duisburg-Essen, Essen, Germany
3Department of Anaesthesiology and Intensive Care Medicine, University of Duisburg-Essen, Essen, Germany
4Department of Diagnostic and Interventional Radiology, University of Duisburg-Essen, Essen, Germany

Received 26 July 2004; revised 16 November 2004; accepted 25 November 2004; online publish-ahead-of-print 26 January 2005.

* Corresponding author. Tel: +49 201 723 4888; fax: +49 201 723 5480. E-mail address: holger.eggebrecht{at}uni-essen.de

See page 431 for the editorial comment on this article (doi:10.1093/eurheartj/ehi119)

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.

Key Words: Aorta • Dissection • Stent • Endovascular • Complication


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