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Stent Grafting of Dissected Descending Aorta in Patients With Marfan's Syndrome

Mid-Term Results

Bertrand Marcheix, MD, MSc^_*, Hervé Rousseau, MD, PhD^,_*, Vanina Bongard, MD, PhD, Robin H. Heijmen, MD, PhD, Christoph A. Nienaber, MD, PhD^||, Marek Ehrlich, MD, PhD^¶, Philippe Amabile, MD, PhD^#, Jean-Paul Beregi, MD, PhD^_**, Rossela Fattori, MD, PhD

^_* Department of Cardiovascular Surgery, Rangueil University Hospital, Toulouse, France
Department of Interventional Radiology, Centre Hospitalier Universitaire, Hôpital de Rangueil, Toulouse, France
Department of Epidemiology and Biostatistics, University Hospital, Toulouse, France
Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands
^|| Department of Radiology, Division of Cardiology, University Hospital Rostock, Rostock, Germany
^¶ Department of Cardiothoracic Surgery, University of Vienna, Vienna, Austria
^# Department of Vascular Surgery, Centre Hospitalier Universitaire, Hôpital Sainte Marguerite, Marseille, France
^_** Radiologie Vasculaire, Hôpital Cardiologique CHRU de Lille, Lille, France
Cardiovascular Radiology, University Hospital S. Orsola, Bologna, Italy

^_* Reprint requests and correspondence: Dr. Hervé Rousseau, Department of Interventional Radiology, Centre Hospitalier Universitaire, Hôpital de Rangueil, Toulouse, France (Email: rousseau.h{at}chu-toulouse.fr).

Objectives: This study sought to assess the safety and the effectiveness of endovascular stent grafting of chronic aortic dissection (AD) in Marfan patients.

Background: The management of chronic AD of the descending thoracic aorta (DTA) is challenging. This is especially true in Marfan patients, who tend to exhibit poor short- and long-term results after conventional surgery.

Methods: Fifteen patients with Marfan's syndrome and chronic AD of the DTA were identified among the 457 patients of the European Talent Registry. All patients underwent endovascular treatment.

Results: No major adverse event was encountered during the procedure. Five patients experienced a primary endoleak (type 1, n = 4; type 2, n = 1). Three of them died, and 1 underwent successful conversion to open surgery. Five other patients experienced secondary endoleak (type 1, n = 4; type 3, n = 1). Four of them underwent successful conversion to either open or endovascular reintervention. Two other patients underwent successful conversion to open repair because of secondary aortic enlargement below the stent graft. After a mean follow-up of 2.1 ± 1.4 years, 12 patients are alive. Of these 12, conversion to open repair was successfully performed in 5 patients. In the remaining 7 patients, complete thrombosis of the false lumen was achieved in 6 patients, with partial thrombosis in 1 patient.

Conclusions: Endovascular stent grafting of the dissected DTA is feasible in selected Marfan patients with low mortality and morbidity rates. Nevertheless, the rate of primary and secondary endoleak is high. Close imaging surveillance is crucial to detect secondary aortic complications and to assess long-term results.

Key Words: aorta • stent graft • endovascular • Marfan's • aortic dissection • acute aortic syndrome

Abbreviations and Acronyms   AD = aortic dissection   ASA = American Association of Anesthesiologists   DTA = descending thoracic aorta