Open Surgical Repair of Descending Thoracic Aortic Aneurysms Linked to Early Postoperative Mortality

Patients undergoing open surgical repair for intact descending thoracic aortic aneurysm had greater odds of early death than patients undergoing TEVAR.

In patients with intact undissected descending thoracic aortic aneurysms, thoracic endovascular aortic repair (TEVAR) resulted in superior mean survival rates compared with open surgical repair, according to study results published in the Journal of the American College of Cardiology. Open surgical repair was associated with higher odds of early postoperative mortality but reduced late hazard of death.

These results indicate that TEVAR should be considered the first line of repair in patients with descending thoracic aortic aneurysms.

The study included participants with intact descending thoracic aortic aneurysms who underwent TEVAR or open surgical repair between 1999 and 2010 with follow-up through 2014 from the Medicare database. The researchers used restricted mean survival time to assess survival, and they used logistic regression to assess perioperative mortality. Secondary outcomes included reintervention.

Through propensity score matching, the researchers formed 2 groups with 1235 open surgical repair participants matched with 2470 TEVAR participants. The median duration of follow-up was 5.6 years in the open surgical repair group and 4.7 in the TEVAR group.

The results indicated that participants in the open surgical repair group had higher odds of perioperative mortality (high-volume center: odds ratio [OR], 1.97; 95% CI, 1.53-2.61; low-volume center: OR, 3.62; 95% CI, 2.88-4.51) compared with participants in the TEVAR group.

At 9 years, the researchers found that the restricted mean survival time difference was better for TEVAR compared with open surgical repair (−209.2 days; 95% CI, −298.7 to −119.7 days; P <.001).

Compared with the TEVAR group, those in the open surgical repair group had a reduced risk for re-intervention (hazard ratio, 0.40; 95% CI, 0.34-0.60; P <.001).

“Despite the lower risk of reintervention and lower late hazard of death, open surgical repair only achieved parity with TEVAR after 9 years, resulting in a substantial survival benefit associated with TEVAR,” the researchers wrote.

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Chiu P, Goldstone AB, Schaffer JM, et al. Endovascular versus open repair of intact descending thoracic aortic aneurysms [published online February 11, 2019.] J Am Coll Cardiol. doi:10.1016/j.jacc.2018.10.086