Is debranching thoracic endovascular aortic repair acceptable as the first choice for arch aneurysm in the elderly?

Abstract

OBJECTIVES:

This study aimed to assess differences in midterm outcomes between total arch replacement (TAR) and debranching thoracic endovascular aortic repair (d-TEVAR) and to evaluate the validity of d-TEVAR as the preferred treatment choice for aortic arch aneurysm in the elderly.

METHODS:

We reviewed the case histories of 86 patients who had undergone TAR (64 men; mean age 78 ± 2.9 years) and 121 patients who had undergone d-TEVAR (90 men; mean age 82 ± 4.5 years) between 2007 and 2017; of these patients, 50 from each group were matched based on propensity scores to adjust for differences in patient characteristics.

RESULTS:

Rates of freedom from all-cause mortality at 2 and 4 years were similar between the 2 groups (88% and 77% in the TAR group vs 82% and 64% in the d-TEVAR group, P = 0.11), but rates of freedom from reintervention at 2 and 4 years were significantly higher in the TAR group (100% and 96%) than in the d-TEVAR group (97% and 88%) (P = 0.004). Propensity score matching yielded similar survival rates of 88% and 85% for TAR vs 86% and 71% for d-TEVAR (P = 0.53) and comparable freedom from reintervention rates (100% and 97% in TAR, 98% and 90% in d-TEVAR, P = 0.16) at 2 and 4 years. Cox regression analysis identified previous cerebral infarction [hazard ratio (HR) 3.9; P = 0.005 in TAR/HR 3.1; P = 0.002 in d-TEVAR] as an independent positive predictor of overall mortality in both groups.

CONCLUSIONS:

Midterm outcomes after TAR and d-TEVAR were satisfactory and propensity score matching-based evaluation revealed no significant differences in outcomes, implying that d-TEVAR is an acceptable first-choice procedure for aortic arch aneurysm in patients older than 75 years.

• Authors: Yoshimasa Seike, Hitoshi Matsuda, Tetsuya Fukuda, Yoshiro Hori, Yosuke Inoue, Atsushi Omura, Kyokun Uehara, Hiroaki Sasaki, Junjiro Kobayashi
• Journal: Interactive cardiovascular and thoracic surgery (Interact Cardiovasc Thorac Surg) Vol. 29 Issue 1 Pg. 101-108 (07 01 2019) ISSN: 1569-9285 [Electronic] England
• PMID: 30805619 (Publication Type: Journal Article, Observational Study)
• Copyright: © The Author(s) 2019. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Topics

• Aged
• Aged, 80 and over
• Aorta, Thoracic (diagnostic imaging, surgery)
• Aortic Aneurysm, Thoracic (diagnosis, surgery)
• Blood Vessel Prosthesis Implantation (methods)
• Endovascular Procedures (methods)
• Female
• Follow-Up Studies
• Humans
• Male
• Propensity Score
• Retrospective Studies
• Risk Factors
• Time Factors
• Tomography, X-Ray Computed
• Treatment Outcome