Abstract
BackgroundThe long-term complication rates of open repair and thoracic endovascular aortic repair (TEVAR) have not yet been determined. Therefore, this study aimed to compare the long-term outcomes and aortic reintervention rates between open repair and TEVAR in patients with descending thoracic aortic pathologies.MethodsBetween January 2002 and December 2017, 230 patients with descending thoracic aortic pathologies underwent surgery. Of these, 136 patients were included in this retrospective study: 45 patients (10, 2, and 33 with dissection, penetrating atherosclerotic ulcer, and pseudoaneurysm, respectively) underwent open repair and 91 patients (27, 1, and 63 with dissection, penetrating atherosclerotic ulcer, and pseudoaneurysm, respectively) underwent TEVAR. The primary end points were in-hospital mortality, and short-term complications. The secondary end points were long-term mortality and reintervention rates. Based on the propensity score matching (PSM), 35 patients who underwent open repair were matched to 35 patients who underwent TEVAR (ratio = 1:1).ResultsThe mean follow-up period was 70.2 ± 51.9 months. Shorter intensive care unit and hospital stay were seen in the TEVAR group than in the open repair group before and after PSM (p < 0.001 and p < 0.001, respectively). However, in-hospital mortality, and spinal cord ischemia were not significantly different among the two groups (before PSM: p = 0.068 and p = 0.211, respectively; after PSM: p = 0.303 and p = 0.314, respectively). The cumulative all-cause death and aorta-related death showed no significant differences between the two groups (before PSM: p = 0.709 and p = 0.734, respectively; after PSM: p = 0.888 and p = 0.731, respectively). However, aortic reintervention rates were higher in the TEVAR group than in the open repair group before and after PSM (p = 0.006 and p = 0.013, respectively).ConclusionThe TEVAR group was superior in short-term recovery outcomes but had higher reintervention rates compared to the open repair group. However, there were no significant differences in long-term survival between the two groups.
Highlights
The long-term complication rates of open repair and thoracic endovascular aortic repair (TEVAR) have not yet been determined
The use of TEVAR has rapidly increased due to improved perioperative morbidity rates, significant postoperative complications associated with TEVAR contribute to its relatively poor results; these complications include, endoleak, stent-graft migration, retrograde type aortic dissection, new-onset dissection, and stent-graft infection [3, 5, 6]
The incidence of connective tissue diseases was significantly higher in the open repair group than in the TEVAR group (p < 0.001)
Summary
The long-term complication rates of open repair and thoracic endovascular aortic repair (TEVAR) have not yet been determined. This study aimed to compare the long-term outcomes and aortic reintervention rates between open repair and TEVAR in patients with descending thoracic aortic pathologies. Since the introduction of thoracic endovascular aortic repair (TEVAR), many reports have demonstrated that it is a safe and feasible alternative to the conventional open. In early clinical results with open repair versus TEVAR covered in previous reports [3, 6, 7], there are little long-term data comparing two procedures. We hypothesized that the advantages of TEVAR, which included less invasive and ease of use, will result in improved long-term outcomes for patients
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