Short-term conversion to open surgery after endovascular stent-grafting of the thoracic aorta: the Talent thoracic registry.

OBJECTIVE: Predictors of late conversion to conventional surgery after thoracic endovascular stent-graft placement are currently unknown.

METHODS: We analyzed data from 422 of 457 consecutive patients who underwent endovascular thoracic repair with the Medtronic Talent thoracic stent-graft (Medtronic/AVE, Santa Rosa, Calif). Of these, 16 patients (3.8%) required late conversion to open surgery during a median follow-up interval of 17 months (range 7-33 months). Six of these patients had undergone previous aortic surgery, 3 patients had previous cardiac surgery, and 5 patients had Marfan syndrome. In patients with late conversion, indications for primary stent-graft placement were dissection in 10 patients, degenerative aneurysm in 5 patients, and penetrating ulcer in 1 patient.

RESULTS: By multivariable Cox analysis, Marfan syndrome (adjusted hazard ratio 9.97, P = .008), type I endoleak (adjusted hazard ratio 3.99, P = .012), the use of more than 1 stent-graft (adjusted hazard ratio 3.89, P = .018), and procedural complications (adjusted hazard ratio 17.50, P = .003) were independent predictors of late conversion.

CONCLUSION: Endovascular treatment for thoracic aortic disease with the Talent stent-graft is associated with a relatively low rate of late conversion to conventional surgery. Better results may be achieved by excluding patients with Marfan syndrome for such a procedure and early aggressive treatment of early type I endoleaks.