Abstract

BACKGROUND: Thoracic endovascular aortic repair (TEVAR) is indicated for treatment of aneurysms, dissections, and traumatic injury. We describe mid-term mortality and re-intervention rates in Medicare beneficiaries undergoing TEVAR.STUDY DESIGN: Patients who underwent TEVAR between 2006-2014 were identified by Current Procedural Terminology (CPT) codes in a 20% Medicare sample. Indication for aortic repair (aneurysm, dissection, trauma) was ascertained via International Classification of Diseases (ICD-9) codes. Follow-up was evaluated until 2015. Kaplan Meier survival analysis and Cox regression were used to compare mortality, with re-intervention and mortality rates expressed as a composite outcome in a hazard ratio with 95% confidence interval (HR 95%CI).RESULTS: 3095 patients underwent TEVAR during the study period: 1465 (47%) for aneurysm 1448 (47%) for dissection, and 182 (5.9%) for trauma. Mean patient age was 74.4 years, and 44.5% were female. Median follow-up was 2.7 years. The overall 30-day, 1-year, and 5-year, and 8-year survival was 93%, 78%, 49%, and 33%, respectively. 30-day mortality was highest in traumatic indications, but overall mortality was highest in patients undergoing TEVAR for aneurysm. Freedom from combined re-intervention and mortality at 30-days, 1-year, 5-years and 8-years was 89%, 73%, 43%, and 29% respectively. Reintervention was highest in patients undergoing TEVAR for dissection (12.8%), followed by aneurysm (10.0%) and trauma (5.5%). Advanced age (HR 1.03 per year, 95%CI 1.02-1.03), congestive heart failure (CHF) (HR 1.48, 95%CI 1.33-1.65), dementia (HR 1.40, 95%CI 1.14-1.28), and rupture (HR 1.38, 95%CI 1.24-1.54) were associated with mortality.CONCLUSION: Midterm survival is lower in patients who undergo TEVAR for dissection and aneurysm compared to trauma. Aneurysmal disease, advanced age, CHF, dementia and aortic rupture are associated with mortality and re-intervention in TEVAR.

View details for DOI 10.1016/j.jamcollsurg.2020.09.011

View details for PubMedID 33022404