Midterm outcome in 158 consecutive gore TAG thoracic endoprostheses: Single center experience

Background. Despite recent improvements in surgical technique, some patients with descending thoracic aortic pathologies are unable to undergo open surgical repair due to significant comorbidities and/ or unfavorable thoracic aortic anatomy. Some of these patients might be able to tolerate a less invasive approach, such as endoluminal grafting. We reviewed our consecutive clinical experience with the Gore TAG endoprosthesis ( W. L. Gore & Assoc, Flagstaff, AZ) for the endovascular exclusion of assorted descending thoracic aortic pathologies in higher surgical risk patients. Methods. After obtaining institutional review board approval, 158 high surgical risk patients underwent attempted delivery of a Gore TAG thoracic endoprosthesis between February 2000 and July 2004. Indications for study enrollment were atherosclerotic aneurysm ( n = 76), aortic dissection ( n = 36), penetrating aortic ulcer ( n = 15), contained rupture ( n = 11), pseudoaneurysm ( n =10), traumatic aortic injury ( n = 5), aortobronchial fistula ( n = 4), and aortic coarctation ( n = 1). Results. The device was successfully delivered in 156 ( 98.7%) patients. Mean patient age was 72 +/- 12.1 years. Three ( 1.9%) patients developed transient paraparesis after graft deployment and 1 ( 0.6%) patient developed paraplegia. While postimplantation endoleaks were observed in 18 ( 11.5%) patients, only 12 patients required reintervention. Thirty- day mortality was 3.8% ( 6 of 156). Mean follow- up was 21.5 +/- 18.8 months, and the overall mortality was 17.3% ( 27 of 156). Conclusions. Endoluminal grafting of multiple types of descending thoracic aorta pathologies with the Gore TAG thoracic endoprosthesis is feasible and safe in higher surgical risk patients. Additional studies and long- term follow- up of these patients are warranted.