Treatment Trends and Outcomes of Open and Endovascular Thoracoabdominal Aortic Repairs in a Single Center

Abstract

Introduction: Fenestrated and branched endovascular aortic repair (F-BEVAR) has been increasingly utilized to treat thoracoabdominal aortic aneurysms (TAAAs). This study evaluates anatomical suitability, treatment trends and outcomes of open surgical repair (OSR) and F-BEVAR of TAAAs in a single center. Methods: We reviewed the clinical data of 303 consecutive patients treated for TAAAs by OSR or F-BEVAR since initiation of an advanced endovascular aortic program in 2007. Anatomical feasibility for F-BEVAR was assessed using computed tomography. Clinical outcomes were analyzed for elective and ruptured Type IV and Types I–III TAAAs, including 30-day mortality, major adverse events (MAEs) and 1-year patient survival and freedom from re-interventions. Results: There were 136 patients (45%, 9 ruptured [6.6%]) treated by OSR (mean age, 61 ± 14 years) and 167 (55%, 7 ruptured [4.2%]) treated by F-BEVAR (mean age, 75 ± 7.9 years, P < .001). Selection of F-BEVAR increased from 14% in the first two years to 77% in the last two years of experience (P < .001). OSR patients had more dissections, were younger and had lower rates of coronary artery disease and stage III–V chronic kidney disease, but similar comorbidity severity scores compared to F-BEVAR patients. Forty-one OSR patients (30%) were not considered candidates for F-BEVAR because of genetically triggered aortic diseases in 29 (21%) or anatomical unsuitability in 15 (11%). Thirty-three OSR patients (30%) would have required adjunctive open surgical procedures to achieve suitability. Thirty-day mortality was 8.1% (n = 11, elective 6.3%, ruptured 33%) for OSR and 3.6% (n = 6, elective 3%, ruptured 14%) for F-BEVAR (P = .09). Thirty-day mortality was similar for elective Type IV (0% vs 0%) and Types I–III TAAAs (8% vs 7.6%) treated by OSR or F-BEVAR, respectively. In the F-BEVAR group, 30-day mortality decreased from 15% (n = 5) in the first 33 patients to 0% in the last 33 patients (P = 0.05). OSR was associated with more MAEs and higher rates of myocardial infarction, respiratory failure, dialysis and longer hospital stay, independent of TAAA Type. Spinal cord injury was for Type IV (7.4% vs 2.1%) and Types I–III TAAAs (5.2% vs 6.1%) treated by OSR or F-BEVAR, respectively. At 1-year, patient survival and freedom from any re-intervention was similar in both groups. Conclusion: F-BEVAR was associated with less MAEs, shorter hospital stay, and similar 30-day mortality for all types of TAAAs. Despite the increasing utilization of F-BEVAR, OSR plays an essential role in the care of TAAA patient because of anatomical unsuitability or genetically triggered aortic diseases. Disclosure of Interest: None Declared.