Thoracic Endovascular Aneurysm Repair versus Open Heart Surgery for Aortic Aneurysm in Octogenarian and over : Single Center Experience
Masato Furui, Takeshi Yoshida, Shoji Sakaguchi, Bunpachi Kakii.
Matsubara Tokushukai Hospital, Matsubara , Osaka, Japan.
OBJECTIVE: Recently, the technology of thoracic endovascular aneurysm repair(TEVAR) has been expanding the possibilities of treatment of very elderly people like octogenarians or nonagenarians that may be hesitant to perform open heart surgery. So we evaluated the results of TEVAR or open heart surgery for arch or descending or thorac-abdominal aortic aneurysm of very elderly people.
METHODS: From May 2005 to November 2015, 256 consecutive patients who had arch or descending or thorac-abdominal aortic aneurysm except for type A aortic dissection were treated in our hospital.Of these, we retrospectively reviewed 59 patients in octogenarians or nonagenarians and compared 34 cases(SG group) which were treated by TEVAR with 25 cases(OS group) which were treated by open heart surgery.
RESULTS: The average age was 83.7±3.0(80-91)years old. Among two groups, there were no significant differences regarding background like sex, age and emergency rate and past medical history such as hypertension, diabetes, renal dysfunction and chronic obstructive pulmonary disease. The SG group demonstrated significantly shorter respiratory management(p=0.005), low rate of tracheotomy(p<0.001), less postoperative cerebral infarction(p=0.002) and shorter postoperative days(0.047). Occurrence of paraplegia, additional treatment and 30 days mortality of SG group were not significantly different from those of OS group. Although there was no significant differences between two groups, SG group had less tendency of long-term hospital death than OS group(3/34,8.8% versus 4/25, 16.0%, p=0.403).
CONCLUSIONS: The patients of TEVAR had shorter respiratory management, low rate of tracheostomy, less postoperative cerebral infarction and shorter postoperative days than those of open heart surgery. Considering the damage of respiratory and complications, TEVAR is less invasive and may be preferable for high risk patients like very elderly people.
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