Reintervention for endograft failures after thoracic endovascular aortic repair

Objective: Thoracic endovascular aortic repair has emerged as an effective therapy for a variety of thoracic aortic pathologic entities. However, endograft failure remains a concern, and its treatment is often challenging. We examined our experience with endograft failure and its treatment by endovascular and open repair. Methods: From January 2000 to January 2012, 680 patients underwent thoracic endovascular aortic repair at the University of Pennsylvania, and their charts were reviewed for the late outcomes and follow-up data. Results: Of the 680 patients, 73 underwent 80 reinterventions (11.7%) during follow-up. The indications for index thoracic endovascular aortic repair were thoracic aortic aneurysms in 381, type A dissection with frozen elephant trunk in 52, type B dissection in 111, hybrid arch repair in 46, traumatic transection in 37, infection in 10, penetrating atherosclerotic ulcer in 25, and others in 18. The median interval from index thoracic endovascular aortic repair to reintervention was 210 days. Endograft failures included endoleak in 45, proximal aortic events in 11, distal aortic events in 15, endograft infection in 3, and others in 6. Endovascular reintervention (n = 80) was performed in 60 patients. In 20 patients, open aortic reconstructive procedures were performed. The overall 30-day mortality was 8.7%(7/80). During follow-up, 10 late deaths occurred. The overall survival in all patients was 81%, 60%, and 52% at 1, 5, and 7 years, respectively. The late survival for patients after reintervention for endograft failure was similar that for the patients who did not require reintervention (P = .31). Conclusions: Reintervention for endograft failure can be performed with acceptable early outcomes. The midterm survival for patients requiring reintervention for endograft failure was similar to that of the patients without endograft failure. Thus, reintervention for endograft failure should be aggressively considered when indicated. (J Thorac Cardiovasc Surg 2013;145:S165-70)