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Indication for endovascular aortic repair affected outcomes
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Patients with acute type B aortic dissections and acute traumatic aortic lesions benefit the most from thoracic endovascular aortic repair, according to recent research.
To assess short- and mid-term results of patients undergoing thoracic endovascular aortic repair for four indications, researchers recruited 300 patients (80 female; median age, 67 years) who underwent the procedure at a single high-volume referral center from 1996 to 2010.
There were 137 descending thoracic aneurysms, 80 type B dissections (60 acute, 20 chronic), 59 perforating aortic ulcers and 24 acute traumatic transections.
Fifteen patients (5%) died in the hospital, of whom seven had descending thoracic aneurysms (5%), four had type B dissections (5%), two had perforating aortic ulcers (3.4%) and two had acute traumatic transections (8%), which was not a statistically significant difference. There was a higher in-hospital mortality seen in acute complicated type B dissections compared with acute uncomplicated type B dissections (12% vs. 0%; P=.01). Preoperative comorbidities had no significant effect on hospital mortality, nor did elective vs. acute cases and acute traumatic injuries compared with complicated acute type B dissections.
Overall, long-term mortality was 86% at 1 year, 63% at 5 years and 44% at 10 years. The early endoleak rate was 18% and the late rate was 8%. Three factors were predictive for long-term mortality: age, chronic obstructive pulmonary disease and previous aortic surgery.
“It is important to note that that long-term survival was significantly different according to indication,” study investigator Dominik Wiedemann, MD, with the department of cardiac surgery and interventional radiology, Medical University of Vienna, told Cardiology Today’s Intervention. “[Patients with] acute traumatic transections have the best long-term survival followed by type B dissections, whereas [those with] descending thoracic aneurysms and perforating aortic ulcers have significantly impaired long-term survival.”
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