Long-term Outcomes of Intervention between Open Repair and Endovascular Aortic Repair for Descending Aortic Syndrome: A Propensity-Matched Analysis

Abstract

Background The long-term complication rates of open repair and thoracic endovascular aortic repair (TEVAR) have not yet been determined. Therefore, this study aimed to compare long-term outcomes and aortic reintervention rates between open repair and TEVAR in patients with descending thoracic aortic diseases. Methods Between January 2002 and December 2017, 230 patients with descending thoracic aortic disease underwent surgery. Among them, 45 patients underwent open repair and 91 underwent TEVAR treatment at Kyungpook National University Hospital. 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, 35 patients who underwent open repair were matched to 35 patients who underwent TEVAR (ratio = 1:1). Results The 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 (p < 0.001 and p < 0.001, respectively). However, in-hospital mortality, and spinal cord ischemia were not significantly different among the two groups (p = 0.068 and p = 0.211 before matching, p = 0.303 and p = 0.314 after matching, respectively). The cumulative all-cause death and aorta-related death showed no significant difference (p = 0.709 and p = 0.734 before matching, p = 0.888 and p = 0.731 after matching, respectively). However, aortic reintervention rates were higher in the TEVAR group than in the open repair group before and after propensity score matching (p = 0.006 and p = 0.013, respectively). Conclusion The TEVAR group was superior in short-term recovery results but had higher reintervention rates compared to the open repair group. However, there was no significant differences between the groups in long-term survival.