Endovascular repair of descending thoracic aortic aneurysms—a mid-term report from the Global Registry for Endovascular Aortic Treatment (GREAT)

Abstract

Abstract   OBJECTIVES The aim of this study was to evaluate the short- to mid-term outcomes of descending thoracic aortic aneurysm (DTAA) repair from the Gore Global Registry for Endovascular Aortic Treatment (GREAT). METHODS This is a multicentre sponsored prospective observational cohort registry. The study population comprised those treated for DTAA receiving GORE thoracic aortic devices for DTAA repair between August 2010 and October 2016. Major primary outcomes were early and late survival, freedom from aorta-related mortality and freedom from aorta-related reintervention. RESULTS There were 180 (58.1%) males and 130 (41.9%) females: the mean age was 70 ± 11 years (range 18–92). The median maximum DTAA diameter was 60 mm (interquartile range 54–68.8). Technical success was achieved in all patients. Operative mortality, as well as immediate conversion to open repair, was never observed. At the 30-day window, mortality occurred in 4 (1.3%) patients, neurological events occurred in 4 (1.3%) patients (transient ischaemic attacks/stroke n = 3, paraplegia n = 1) and the reintervention rate was 4.5% (n = 14). Estimated survival was 95.6% [95% confidence interval (CI) 92.6–97.4] at 6 months, 92.7% (95% CI 89.1–95.2) at 1 year and 57.3% (95% CI 48.5–65.1) at 5 years. Freedom from aorta-related mortality was 98.3% (95% CI 96.1–99.3) at 6 months, 98.3% (95% CI 96.1–99.3) at 1 year and 92.2% (95% CI 83.4–96.4) at 5 years. Freedom from thoracic endovascular aortic repair (TEVAR)-related reintervention at 5 years was 87.2% (95% CI 81.2–91.4). CONCLUSIONS TEVAR for DTAAs using GORE thoracic aortic devices is associated with a low rate of device-related reinterventions and is effective at preventing aorta-related mortality for up to 5 years of follow-up. Clinical registration number NCT number: NCT01658787. Subject collection 161, 164.