Debranching thoracic endovascular aortic repair for distal aortic arch aneurysm in elderly patients aged over 75 years old

Abstract

Background: We examined the outcome of debranching thoracic endovascular aortic repair (d-TEVAR) without sternotomy for distal aortic arch aneurysm in patients aged ≥75 years. Methods: Patients who underwent d-TEVAR or TAR for aortic arch aneurysm between 2008 and 2015 at our hospital and aged ≥75 years were included. Age, sex, left ventricular ejection fraction, preoperative creatinine level, diabetes, cerebrovascular disease, and chronic obstructive pulmonary disease were matched using PS. Results: Among 74 patients (d-TEVAR: 51, TAR: 23), 17 patients in each group were matched. No difference in surgical outcome was detected between the d-TEVAR and TAR groups, including 30-day death (0% vs. 0%), hospital death (5.8% vs. 0%: p = 0.31) and incidence of cerebral infarction (5.8% vs. 7.6%: p = 0.27) as well as the long-term outcomes of 5-year survival (92.8% vs. 74.8%: p = 0.30) and 5-year aorta-related event-free rate (88.2% vs. 100%: p = 0.15). Average duration of ICU stay (1.3 ± 1.1 days vs. 5.6 ± 1.3 days: p = 0.025) and hospital stay (16.5 ± 5.2 days vs. 37.7 ± 19.6 days: p = 0.017) were significantly shorter in the d-TEVAR group. Conclusion: Our results indicated that d-TEVAR is less invasive without affecting long-term outcome up to 5 years. Although the number of the patients included in the study was small, debranching TEVAR could be one of the treatments of the choice in the elderly, especially with comorbidities.

Total arch replacement versus hybrid operation for aortic arch aneurysm in elderly patients: a retrospective cohort analysis

“…However, TEVAR grafts were associated with an increased risk of re-intervention, the majority of which occurred within 3 years after surgery. The findings of the current study were in agreement with previous evidence suggesting that the majority of re-interventions occurred within 3 years of hybrid surgery, with the approximate freedom from re-intervention rate being 80–95% ( 20 - 23 ). The life-expectancy in South Korea in 2020 was 83.5 years ( 24 ).…”

Short-term results of fenestrated physician-modified endografts for type1a endoleak after conventional thoracic endovascular aortic repair

“…Debranching TEVAR has been shown to be effective in the long term for distal aortic arch aneurysm exclusion, especially in high-risk patients. 9 Voigt and colleagues found a high risk of peripheral nervous lesions, with 25% phrenic lesions, 5% recurrent lesions, and 2% axillary plexus lesions, associated with a substantial risk of loss of vision and mortality during the period between the 2 surgical stages when patients do not show up for the second operation 10 ; Konstantinou and colleagues 11 reported that debranching TEVAR resulted in more perioperative complications and required a longer operative time compared with fenestrated TEVAR.…”

Assessment of the Effectiveness of Zone 1-Landing Hybrid TEVAR by Comparing Its Outcomes with Those of Zone 2-Landing Hybrid TEVAR

“…However, despite recent developments in surgical techniques and the perioperative management of aortic arch diseases, TAR, which requires sternotomy, hypothermic circulatory arrest, selective cervical arterial perfusion, and cardiopulmonary bypass, remains a high-risk procedure, particularly in older adults with significant comorbidities [ 14 , 15 , 16 , 17 ]. Some previous studies have reported that high-risk patients aged > 75 years have significantly lower in-hospital mortality, and hybrid TEVAR improves short- and mid-term outcomes, particularly in high-risk patients [ 18 , 19 ]. Some recent studies reported that the long-term results of hybrid TEVAR are equivalent to those of TAR [ 20 , 21 , 22 , 23 ].…”