Thoracic Endovascular Aortic Repair Using a Branched Endograft Versus Open Arch Surgery

Background: This study investigated whether branched thoracic endovascular aortic repair (bTEVAR), a treatment for distal aortic arch diseases, could serve as an alternative to open aortic surgery (OAS). Methods: This single-center, retrospective, observational cohort study comprised 80 patients (bTEVAR, n = 28; TAR, n = 52) treated from October 2012 to June 2018. The median age and median follow-up periods were 73 years (interquartile range [IQR], 66-79 years) and 6.0 years (IQR, 2.8-9.7 years). Results: The patients in the bTEVAR group were older than those in the OAS group (p < 0.001), and the EuroSCORE2 was significantly higher in the bTEVAR group (6.6%) than in the OAS group (2.4%; p < 0.001). There were no 30-day or in-hospital mortalities in either group. Stroke was observed in four (5.0%) patients, all of whom were in the bTEVAR group (p = 0.013). However, no other significant differences were observed between the two groups in other early aortic events. Kaplan-Meier curves regarding the survival, aorta-related death, and aortic events showed no significant differences between the two groups. Conclusions: Although bTEVAR involves an older patient population and a higher surgical risk, the early and mid-term outcomes were comparable to those of OAS, except for cerebral infarction. However, because cerebral infarction significantly reduces a patient's quality of life, for bTEVAR to become more widespread, it is necessary to reduce the incidence of cerebral infarction.