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Total arch replacement versus debranching thoracic endovascular aortic repair for aortic arch aneurysm: what indicates a high-risk patient for arch repair in octogenarians?

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Abstract

Objectives

This study aimed to reveal the differences in intermediate outcomes between TAR and d-TEVAR in octogenarians and to identify risk factors for adverse events after aortic arch repair in octogenarians.

Methods

We reviewed medical records of 125 patients aged > 80 years who underwent surgical intervention for aortic aneurysm between 2008 and 2016. Of these, 60 underwent conventional TAR (43 men; age, 82 ± 2.2 years) and 65 underwent d-TEVAR (49 men; age, 84 ± 3.4 years).

Results

Freedom from all causes of mortality at 2 and 4 years was similar (80 and 66% in TAR, 80 and 51% in d-TEVAR, p = 0.17). Freedom from aortic death at 2 and 4 years was similar (88 and 88% in TAR, 87 and 76% in d-TEVAR, p = 0.86). Using Cox regression analysis, chronic obstructive pulmonary disease (COPD) [hazard ratio (HR), 6.0; p = 0.008], malignancy (HR, 8.8; p = 0.004), previous cardiac and thoracic aortic surgery (required median sternotomy) (HR, 65.9; p = 0.012), perioperative stroke (HR, 12.6; p = 0.012), and postoperative pneumonia (HR, 5.8; p = 0.026) were identified as independent positive predictors of overall postoperative mortality for TAR, whereas neurological dysfunction (HR, 3.0; p = 0.016) and perioperative stroke (HR, 12.1; p = 0.023) were identified for d-TEVAR.

Conclusions

TAR in octogenarians with COPD and/or malignancy showed higher mortality rates; d-TEVAR is more appropriate in these situations. The prevention of perioperative stroke, which is related with poor prognosis in both the groups, is critical.

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Authors and Affiliations

  1. Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan

    Yoshimasa Seike, Hitoshi Matsuda, Yosuke Inoue, Atsushi Omura, Kyokun Uehara, Hiroaki Sasaki & Junjiro Kobayashi

  2. Department of Radiology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan

    Tetsuya Fukuda

Authors
  1. Yoshimasa Seike
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  2. Hitoshi Matsuda
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  3. Tetsuya Fukuda
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  4. Yosuke Inoue
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  5. Atsushi Omura
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  6. Kyokun Uehara
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  7. Hiroaki Sasaki
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  8. Junjiro Kobayashi
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Correspondence to Hitoshi Matsuda.

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Seike, Y., Matsuda, H., Fukuda, T. et al. Total arch replacement versus debranching thoracic endovascular aortic repair for aortic arch aneurysm: what indicates a high-risk patient for arch repair in octogenarians?. Gen Thorac Cardiovasc Surg 66, 263–269 (2018). https://doi.org/10.1007/s11748-018-0894-1

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  • DOI: https://doi.org/10.1007/s11748-018-0894-1

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