Objective: Many patients requiring repair of the thoracic aorta are admitted to our institution under emergency conditions. The cardiovascular team that decides whether conventional surgery or endografting is indicated also performs the procedure. After 7 years of experience our results are reviewed.
Methods: Between September 1999 and December 2006 emergency stent grafting of the thoracic aorta was performed in 134 patients. This subset represents 60 % of our overall experience in thoracic endografting (n = 222). All procedures were performed in the operation room with a surgical C-arm and TEE for intraoperative imaging and angiography. Various types of devices were implanted: (73 Talent^®, 50 E-vita^®, 6 Relay^®, 2 Zenith^®, 1 Valiant^®, 1 Endofit^®, 1 Gore-TAG^®). Details of the patients are given in the table. Emergency indications were: active bleeding in 23 (17%), contained rupture in 64 (48%), malperfusion in type-B dissections in 22 (16%) and symptomatic aneurysms in 25 (19%). In 87% (n = 117) of the patients open surgery carried a high risk or was unsuitable.
Results: Primary technical success was achieved in 84% and secondary (after further interventions) in 90% (n=120) . Eight conversions to open repair were necessary, 4 during the procedures and 4 secondarily before discharge. Thirty-day mortality was 17.9% (n=24). Eight deaths were related to the devices, 11 to concomitant diseases or trauma and 5 to complications of aortic rupture despite successful stent-graft implantation. Paraplegia occurred in 2.2% (n=3). During follow-up of 1 month to 7 years the cumulative 5-year-survival rate was 60 % with most patients dying for reasons mainly related to comorbidity.
Conclusions: In our experience almost two thirds of thoracic aortic stent-graft procedures are performed in emergency situations. The mortality rate of 17.9% in these patients is deemed acceptable. The midterm actuarial survival is good considering the preoperative conditions. Therefore even patients in whom open repair of the thoracic aorta is not feasible can be offered a reasonable chance of survival using this minimally invasive method.