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Post-TEVAR mortality risk higher in women
Recently published data suggest that female sex should be considered when analyzing the benefits and risks of thoracic endovascular aortic repair for descending thoracic aortic aneurysm.
In a retrospective review of all TEVAR procedures for intact descending thoracic aortic aneurysm performed from 2011 to 2015 in the Society for Vascular Surgery Vascular Quality Initiative registry (n = 2,574; 40% women), mortality was higher for women, as compared with men, at two timepoints: 30 days (5.4% vs. 3.3%; P < .01) and 1 year (9.8% vs. 6.3%; P < .01).
After adjustment for age, aortic size index, symptoms and comorbidities, female sex remained associated with increased 30-day mortality (OR = 1.5; 95% CI, 1.1-2.1) and worse long-term survival (HR = 1.3; 95% CI, 1.03-1.6) after TEVAR, the researchers found.
After TEVAR, women were also more likely than men to experience a major adverse event (7.6% vs. 4.3%; P < .001). Additionally, reintubation (6.6%) vs. 4.7%; P = .04), treatment with new postoperative renal-replacement therapy (0.8% vs. 0.2%; P =.03) and postoperative transfusion (29% vs. 19%; P < .001) were more common in women than men. Women also had longer lengths of stay in the hospital (median, 5 vs. 4 days; P < .001) and ICU (2.5 vs. 2 days; P < .001) and were less likely to be discharged home (75% vs. 86%; P <. 001).
Baseline characteristics showed that women, as compared with men, were slightly older (73 vs. 72 years; P = .03) and were less likely to be white (75% vs. 81%; P < .001), to have known CAD (19% vs. 26%; P < .001), to have had prior PCI or CABG (15% vs. 31%; P < .001) or to have had any prior aortic intervention (23% vs. 30%; P < .001). Women also had smaller aortic diameters but larger aortic size indices after accounting for body size (3.2 cm/m2 vs. 2.8 cm/m2; P < .001).
Chronic obstructive pulmonary disease and preoperative anemia, however, were more common among women than men.
At presentation, women were more likely to be symptomatic (16% vs. 10%; P < .001) and therefore were more likely to have a nonelective procedure (79% vs. 85%; P < .001). Estimated blood loss greater than 500 mL was more common in women (20% vs. 17%; P = .04), as was transfusion (29% vs. 21%; P < .001). Women were also more likely than men to undergo iliac access procedures (4.3% vs. 2.1%; P < .01), according to the study results.
“Female patients have higher mortality than male patients after TEVAR in a real-world population, even after adjusting for their older age and increased medical comorbidities,” Sarah E. Deery, MD, from the division of vascular and endovascular surgery at Beth Israel Deaconess Medical Center and Harvard Medical School, said in a press release. “Further research into the cause of these sex differences will allow us to determine the optimal threshold for repair of thoracic aortic aneurysms in female patients.” – by Melissa Foster
Disclosure: One researcher reports receiving consultant fees from Endologix and Medtronic.