TY - JOUR
T1 - Improved midterm outcomes after endovascular repair of nontraumatic descending thoracic aortic rupture compared with open surgery
AU - Ogawa, Yukihisa
AU - Watkins, A. Claire
AU - Lingala, Bharathi
AU - Nathan, Itoga
AU - Chiu, Peter
AU - Iwakoshi, Shinichi
AU - He, Hao
AU - Lee, Jason T.
AU - Fischbein, Michael
AU - Woo, Y. Joseph
AU - Dake, Michael D.
N1 - Publisher Copyright: © 2019 The American Association for Thoracic Surgery
PY - 2021/6
Y1 - 2021/6
N2 - Background: Thoracic endovascular aortic repair (TEVAR) has become first-line treatment for descending thoracic aortic rupture (DTAR), but its midterm and long-term outcomes remain undescribed. This study evaluated whether TEVAR would improve midterm outcomes of nontraumatic DTAR relative to open surgical repair (OSR). Methods: Between December 1999 and October 2018, 118 patients with DTAR were treated with either OSR (n = 39) or TEVAR (n = 79) at a single center. Primary end points were 30-day and long-term all-cause mortalities. Secondary end points included stroke, permanent spinal cord ischemia (SCI), prolonged ventilation support or tracheostomy, permanent hemodialysis, and aortic reintervention. Results: Thirty-day mortality was significantly lower with TEVAR (OSR, 38.5%; TEVAR, 16.5%; P =.01). Stroke (15.6% vs 3.8%; P =.03), permanent SCI (15.6% vs 2.5%; P =.02), prolonged ventilation (30.8% vs 8.9%; P =.002), and tracheostomy (12.8% vs 2.5%; P =.04) were significantly lower after TEVAR than OSR. Need for hemodialysis trended higher after OSR (12.8% vs 5.1%; P =.2). Mean follow ups were 1048 ± 1591 days for OSR group and 828 ± 1258 days for TEVAR. All-cause mortality at last follow-up was significantly lower after TEVAR than OSR (35.4% vs 66.7%; P =.001). Aortic reintervention was required more frequently within 30 days after TEVAR (15.2% vs 2.6%; P =.06). By multivariate analysis, TAAA was an independent predictor for mortality. Conclusions: TEVAR improves both early and midterm outcomes of DTAR relative to OSR. TAAA was a predictor of mortality. Endovascular approach to DTAR may provide the greatest chance at survival.
AB - Background: Thoracic endovascular aortic repair (TEVAR) has become first-line treatment for descending thoracic aortic rupture (DTAR), but its midterm and long-term outcomes remain undescribed. This study evaluated whether TEVAR would improve midterm outcomes of nontraumatic DTAR relative to open surgical repair (OSR). Methods: Between December 1999 and October 2018, 118 patients with DTAR were treated with either OSR (n = 39) or TEVAR (n = 79) at a single center. Primary end points were 30-day and long-term all-cause mortalities. Secondary end points included stroke, permanent spinal cord ischemia (SCI), prolonged ventilation support or tracheostomy, permanent hemodialysis, and aortic reintervention. Results: Thirty-day mortality was significantly lower with TEVAR (OSR, 38.5%; TEVAR, 16.5%; P =.01). Stroke (15.6% vs 3.8%; P =.03), permanent SCI (15.6% vs 2.5%; P =.02), prolonged ventilation (30.8% vs 8.9%; P =.002), and tracheostomy (12.8% vs 2.5%; P =.04) were significantly lower after TEVAR than OSR. Need for hemodialysis trended higher after OSR (12.8% vs 5.1%; P =.2). Mean follow ups were 1048 ± 1591 days for OSR group and 828 ± 1258 days for TEVAR. All-cause mortality at last follow-up was significantly lower after TEVAR than OSR (35.4% vs 66.7%; P =.001). Aortic reintervention was required more frequently within 30 days after TEVAR (15.2% vs 2.6%; P =.06). By multivariate analysis, TAAA was an independent predictor for mortality. Conclusions: TEVAR improves both early and midterm outcomes of DTAR relative to OSR. TAAA was a predictor of mortality. Endovascular approach to DTAR may provide the greatest chance at survival.
KW - descending thoracic aortic diseases
KW - rupture
KW - thoracic endovascular aortic repair
UR - http://www.scopus.com/inward/record.url?scp=85077660032&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85077660032&partnerID=8YFLogxK
U2 - 10.1016/j.jtcvs.2019.10.156
DO - 10.1016/j.jtcvs.2019.10.156
M3 - Article
C2 - 31926735
SN - 0022-5223
VL - 161
SP - 2004
EP - 2012
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
IS - 6
ER -