Elsevier

The Annals of Thoracic Surgery

Volume 94, Issue 5, November 2012, Pages 1394-1399
The Annals of Thoracic Surgery

Original article
Adult cardiac
Results of Thoracic Endovascular Aortic Repair 6 Years After United States Food and Drug Administration Approval

Presented at the Forty-eighth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 28–Feb 1, 2012.
https://doi.org/10.1016/j.athoracsur.2012.05.072Get rights and content

Background

Since United States Food and Drug Administration approval in 2005, the short-term safety and efficacy of thoracic endovascular aortic repair (TEVAR) have been established. However, longer-term follow-up data remain lacking. The objective of this study is to report 6-year outcomes of TEVAR in clinical practice.

Methods

A prospective cohort review was performed of all patients undergoing TEVAR at a single referral institution between March 2005 and May 2011. Rates of reintervention were noted. Overall and aortic-specific survival were determined using Kaplan-Meier methods. Log-rank tests were used to compare survival between groups.

Results

During the study interval, 332 TEVAR procedures were performed in 297 patients. Reintervention was required after 12% of procedures at a mean of 8 ± 14 months after initial TEVAR and was higher in the initial tercile of patients (15.0% vs 9.9%). The 6-year freedom from reintervention was 84%. Type I endoleak was the most common cause of reintervention (5%). Six-year overall survival was 54%, and aorta-specific survival was 92%. Long-term survival was significantly lower than that of an age- and sex-matched United States population (p < 0.001). Survival was similar between patients requiring a reintervention vs those not (p = 0.26). Survival was different based on indication for TEVAR (p = 0.007), and patients with degenerative aneurysms had the lowest survival (47% at 6 years). Cardiopulmonary pathologies were the most common cause of death (27 of 93 total deaths).

Conclusions

Long-term aortic-related survival after TEVAR is high, and the need for reintervention is infrequent. However, overall long-term survival is low, particularly for patients with degenerative aneurysms, and additional work is needed to identify patients unlikely to derive a survival benefit from TEVAR.

Section snippets

Patients and Methods

This study was reviewed and approved by the Institutional Review Board of Duke University, and the need for individual patient consent was waived.

Results

During the study interval, 332 TEVAR procedures were performed in 297 patients (Table 1). Procedures included descending only (66%), hybrid arch (19%), and hybrid thoracoabdominal (15%) repair. The 30-day/in-hospital mortality rate was 6%. The rates of postoperative permanent paraparesis/paraplegia and stroke were 1.8% and 1.8%, respectively. Acute kidney injury requiring any postoperative dialysis occurred after 3.3% of procedures. Operative characteristics are presented in Table 2. Primary

Comment

Recent reports of sobering rates of reintervention and late death [4, 5] have raised questions about the durability and appropriate use of TEVAR. In this large, single-center series, we demonstrate that TEVAR can be performed with a low rate of reintervention (12%) and high rate of aorta-specific long-term survival (92% at 6 years). Further, reintervention rates decreased by 50% after the initial tercile of patients treated, likely related to the availability of newer-generation devices over

References (20)

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