Circulation Topic Review

Endovascular repair is increasingly being adopted as the treatment of choice for many thoracic aortic conditions. As the application of this technology widens, developing an evidence-based understanding of which patients are most likely to benefit is a priority. A barrier to this has been the relatively few number of procedures that are performed, so that randomized controlled trials on the scale of those performed for infrarenal aortic aneurysm have not been feasible. At present, many published series fail to discriminate between different aortic pathologies when outcomes are reported, making pooled analysis difficult. This first report from the Medtronic Thoracic Endovascular Registry (MOTHER) combines raw data from 5 trials and 1 institutional series, characterizing the difference in early outcomes between the major pathology groups. Regional trends in practice suggest that thoracic endovascular repair has complemented open surgery rather than replaced it and has allowed more patients to be offered therapy than was previously possible. Significantly, some will have been deemed unfit for open surgery because of poor physiological reserve, and although thoracic endovascular aortic repair all but abolishes aortic death, individuals remain subject to an increased risk of mortality from all other causes in comparison with matched controls. Follow-up data collected for the component registries have allowed a description of midterm survival in such patients, and this report serves to highlight the importance of considering all-cause mortality in aneurysm patients and to reinforce the ability of thoracic endovascular aortic repair to prevent aortic-related death in both aneurysm and dissection patients.