Stent-graft repair versus open surgery for the descending aorta: a case-control study

To compare the clinical outcomes of open surgery versus endovascular repair in patients with pathologies of the descending thoracic aorta (DTA).

This retrospective study included 44 patients (28 men; mean age 68+/-12 years, range 37-86) treated for DTA pathologies between 1995 and 2003. Twenty-two patients (15 men; mean age 68+/-13 years, range 37-86) undergoing stent-graft implantation were matched for sex, age, emergency operation, and comorbidities (coronary artery disease, chronic obstructive pulmonary disease) with a 22-patient contemporaneous surgical cohort (13 men; mean age 69+/-11 years, range 41-80).

Thirty-day mortality was 5% in the stent-graft group and 27% in the open surgery group (p=0.047). The incidences of postoperative stroke and paraplegia were both 5% in the stent-graft group and 9%, respectively, in the open surgery cohort. One patient required a second stent-graft due to an endoleak during the same hospital stay, and 2 reoperations were performed in the standard operation group (p = NS). Lengths of stay in the intensive care unit (ICU) and hospital were 4.3+/-5.4 and 11.9+/-15.0 days, respectively, in the stent-graft group and 10.0+/-7.4 and 21.5+/-17.4 days, respectively, in the open surgery group (p<0.006).

Stent-graft repair was associated with lower 30-day mortality and comparable complication rates in older patients with significant comorbidities and a high percentage of emergency operations compared to open surgery. Stent-graft implantation shortens ICU and hospital stays significantly. In the future, subgroups of patients who may experience the greatest benefit from stent-graft repair in the long term should be defined.