GORE TAG Thoracic Endograft with Active Control System: Landing Accuracy and Wall Apposition in an Initial Clinical Experience

Abstract

The aim was to describe a single-center experience with the Conformable GORE TAG Thoracic Endoprosthesis (C-TAG) with active control system, specifically designed to evaluate the accuracy of proximal and distal deployment and its capability to adapt to the aortic wall. This is a single-center prospective study including all patients treated with the C-TAG with active control system for thoracic aorta pathologies from September 2017 to May 2018. Proximal and distal accuracy of deployment was measured as the distance between "intended" and "actual landing" zone measured on the digital subtraction angiography images. Mean lack of wall apposition was measured at postoperative computed tomography (CT) angiogram images as the distance between the proximal or distal graft radiopaque ring marker and the point of graft aortic complete apposition, using parasagittal multiplanar reconstructions. Eleven cases were treated: 6 atherosclerotic aneurysms (5 descending and 1 arch), 1 dissecting aneurysm, 2 type B acute dissections, 1 thoracic pseudoaneurysm, and 1 Kommerell diverticulum. The proximal deployment was in landing zone 3 in 6 cases (54%), 2 in 2 cases (18%), 1 in 1 case (9%), and 0 in 2 (18%). The distal landing was in zone 4 in 1 case (9%), zone 5 in 9 cases (81%), and in 1 case (9%), it was in zone 6 with intentional coverage of the celiac trunk. Rapid pacing was used only in 2 cases. Mean accuracy of deployment was 1.8±1.3mm for the proximal and 0.7±1mm for the distal landing zones. Mean lack of wall apposition was 1.1±1.9mm at the proximal landing zone and 0.6±1.8mm at the distal landing zone. The C-TAG with active control system offers accurate deployment both at the proximal and at the distal levels. The conformability, staged deployment, and angulation control allow good adaptation to aortic arch and precise deployment.