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A Comparison of Open and Endovascular Descending Thoracic Aortic Repair in Patients Older Than 75 Years of Age

2008; Elsevier BV; Volume: 85; Issue: 5 Linguagem: Inglês

10.1016/j.athoracsur.2008.01.044

1552-6259

Himanshu J. Patel, David M. Williams, Gilbert R. Upchurch, Narasimham L. Dasika, Mary C. Passow, Richard L. Prager, G. Michael Deeb,

Cardiac, Anesthesia and Surgical Outcomes

BackgroundThoracic aortic endovascular repair (TEVAR) holds great promise in the elderly population. We conducted a concurrent comparison of TEVAR with open descending thoracic aneurysm repair (DTAR) in elderly patients to determine the more appropriate therapeutic option.MethodsSince 1993, 93 patients aged 75 years and older have undergone open (n = 41) or endovascular (n = 52) descending aortic repair. Intervention indications included aneurysms, dissection, or traumatic injury. Mean maximum aortic diameter was 6.1 cm. Contained rupture was more frequent in TEVAR (p = 0.005); 52 needed arch repair, and 46 needed total descending repair.ResultsThe mean age was 78.9 years (TEVAR, 80.6 vs DTAR, 76.9; p < 0.0001). The TEVAR patients had more significant comorbidities; 42 (80.8%) were prospectively identified as nonoperative candidates. Thirty-day mortality was higher in DTAR at 7 (17.1%) vs TEVAR at 3 (5.7%, p = 0.1). The composite end point of 30-day death, stroke, permanent paralysis, or dialysis requirement was similar (TEVAR, 9; DTAR, 10; p = 0.45). Median postoperative length of stay was shorter in TEVAR (6 days) vs DTAR (13 days; p = 0.003). Endoleaks were observed in 12. Actuarial survival at 48 months was similar (mean survival: TEVAR, 30.2 months vs DTAR, 33.7 months; p = 0.49).ConclusionsDespite more complex preoperative comorbidities, the TEVAR group had shorter hospitalization, a trend towards a reduction in early mortality, and similar late outcomes. This comparative analysis suggests that thoracic endovascular repair may be a more suitable therapeutic option in this complex elderly group. Thoracic aortic endovascular repair (TEVAR) holds great promise in the elderly population. We conducted a concurrent comparison of TEVAR with open descending thoracic aneurysm repair (DTAR) in elderly patients to determine the more appropriate therapeutic option. Since 1993, 93 patients aged 75 years and older have undergone open (n = 41) or endovascular (n = 52) descending aortic repair. Intervention indications included aneurysms, dissection, or traumatic injury. Mean maximum aortic diameter was 6.1 cm. Contained rupture was more frequent in TEVAR (p = 0.005); 52 needed arch repair, and 46 needed total descending repair. The mean age was 78.9 years (TEVAR, 80.6 vs DTAR, 76.9; p < 0.0001). The TEVAR patients had more significant comorbidities; 42 (80.8%) were prospectively identified as nonoperative candidates. Thirty-day mortality was higher in DTAR at 7 (17.1%) vs TEVAR at 3 (5.7%, p = 0.1). The composite end point of 30-day death, stroke, permanent paralysis, or dialysis requirement was similar (TEVAR, 9; DTAR, 10; p = 0.45). Median postoperative length of stay was shorter in TEVAR (6 days) vs DTAR (13 days; p = 0.003). Endoleaks were observed in 12. Actuarial survival at 48 months was similar (mean survival: TEVAR, 30.2 months vs DTAR, 33.7 months; p = 0.49). Despite more complex preoperative comorbidities, the TEVAR group had shorter hospitalization, a trend towards a reduction in early mortality, and similar late outcomes. This comparative analysis suggests that thoracic endovascular repair may be a more suitable therapeutic option in this complex elderly group.