Advances in Treatment and Long-term Survival in Patients with Descending Thoracic Aortic Aneurysms Treated at a...

We report long-term survival in open surgical and endovascular patients treated for descending thoracic aortic aneurysms (TAAs) at a single tertiary center from 1984 to 2014 to study the impact of transition to thoracic endovascular aortic repair (TEVAR) for TAA repair.

Using a prospectively maintained registry, all patients (n = 202) having open or endovascular repair (TEVAR) of descending TAAs were studied. Date of last contact or death was obtained on all patients from hospital records, Social Security Death Database, and verified online records. Survival curves were computed and compared by age, preoperative variables, surgical approach, and hospital complications. Proportional hazards models were used for multivariate analysis of survival.

In total, 28% had dissection, 41.6% presented acutely, 68.8% had TEVAR, and 31.1% had open surgery. Spinal cord injury (SCI) occurred in 0.5% and stroke in 1%. Operative mortality (5.9%) was associated with acuity, respiratory failure, open approach, and age. One-year survival in all patients was 83.7%. One-year mortality was associated with acuity, open surgery, respiratory failure, hospital complications, and coronary artery bypass surgery (CABG). Five-year survival was 60.4% and not associated with other variables. One-year survival was 76% in open patients and 87% in TEVAR patients. When operative mortality was excluded, 1-year survival was 89% and 5-year survival was 64.2% and there was no difference in long-term survival between TEVAR and open surgery. One-year mortality was associated with CABG and hospital complications. No variables were associated with 5-year survival. Ten-year survival was 35% and predicted only by age at operation.

Operative mortality was higher in open surgery than TEVAR, but after 30 days, long-term survival was the same. Eighty-nine percent of patients were alive 1 year after surgery and 64% were alive 5 years after surgery. Low SCI contributed to longer survival.