Improved midterm outcomes after endovascular repair of nontraumatic descending thoracic aortic rupture compared with open surgery.

Abstract

BACKGROUND: Thoracic endovascular aortic repair (TEVAR) has become first-line treatment for descending thoracic aortic rupture (DTAR), but its midterm and long-term outcomes remain undescribed. This study evaluated whether TEVAR would improve midterm outcomes of nontraumatic DTAR relative to open surgical repair (OSR).METHODS: Between December 1999 and October 2018, 118 patients with DTAR were treated with either OSR (n=39) or TEVAR (n=79) at a single center. Primary end points were 30-day and long-term all-cause mortalities. Secondary end points included stroke, permanent spinal cord ischemia (SCI), prolonged ventilation support or tracheostomy, permanent hemodialysis, and aortic reintervention.RESULTS: Thirty-day mortality was significantly lower with TEVAR (OSR, 38.5%; TEVAR, 16.5%; P=.01). Stroke (15.6% vs 3.8%; P=.03), permanent SCI (15.6% vs 2.5%; P=.02), prolonged ventilation (30.8% vs 8.9%; P=.002), and tracheostomy (12.8% vs 2.5%; P=.04) were significantly lower after TEVAR than OSR. Need for hemodialysis trended higher after OSR (12.8% vs 5.1%; P=.2). Mean follow ups were 1048±1591days for OSR group and 828±1258days for TEVAR. All-cause mortality at last follow-up was significantly lower after TEVAR than OSR (35.4% vs 66.7%; P=.001). Aortic reintervention was required more frequently within 30days after TEVAR (15.2% vs 2.6%; P=.06). By multivariate analysis, TAAA was an independent predictor for mortality.CONCLUSIONS: TEVAR improves both early and midterm outcomes of DTAR relative to OSR. TAAA was a predictor of mortality. Endovascular approach to DTAR may provide the greatest chance at survival.

View details for DOI 10.1016/j.jtcvs.2019.10.156

View details for PubMedID 31926735