Pathology Specific Aortic Outcomes After Thoracic Endovascular Aortic Repair (tevar)
Michele Gallo1, Manuela Riggi2, Jos van den Berg3, Susanna Grego4, Enrico Ferrari1
1Cardiac Surgery Dpt, Cardiocentro Ticino Foundation, Lugano, Switzerland, 2Cardiocentro Ticino Foundation, Lugano, Switzerland, 3Interventional Radiology, Ospedale Regionale di Lugano, Lugano, Switzerland, 4Cardiology Dpt, Cardiocentro Ticino Foundation, Lugano, Switzerland
Background: Thoracic endovascular aortic repair (TEVAR) has become a recognized treatment for several thoracic aortic diseases. We evaluated the long-term outcomes of TEVAR stratified by specific aortic pathologies. Methods: Between June 2002 and November 2019, 111 patients were treated with TEVAR. Patients were divided according to the indication for implanting TEVAR. Demographics, preoperative characteristics and intra and postoperative outcomes were evaluated. Overall and aortic-specific survival were determined using Kaplan-Meier methods. Log-rank tests were used to compare survival between groups. Cox regression was used to identify predictors of endoleak. Results: Patients were stratified in 5 groups according to the indication for TEVAR. A total of 47 (42%) underwent TEVAR for aneurismatic aortic disease, 24 (21%) for type B aortic dissection, 21 (18%) for penetrating aortic ulcer, 10 (9%) for type A aortic dissection and 9 (8%) for post-traumatic aortic injury. Patients with post-traumatic aortic injury are younger(p=0.001), have less hypertension (p=0.001), less diabetes (p=0.029), less peripheral vascular disease (p=0.042) and less prior PCI stent (p=0.033). Patients with aneurismatic aortic disease present a significantly higher preoperative creatinine level (p=0.017). No difference between groups were observed for left ventricular ejection fraction (p=0.178). Survival was different based on the indication for TEVAR (log rank 0.024). Patients with type A aortic dissection had the lowest survival (50% at 5 years) and survival for aneurysmatic aortic disease was 55% at 5 years. Patients with traumatic aortic injury present 100% survival at 5 years, while the survival for type B aortic dissection and penetrating aortic ulcer at 5 years were 83% (Figure 1). During follow up, no specific aortic pathologies requiring TEVAR were related to endoleak development (hazard ratio 0.741; 95% confidence interval 0.231 - 2.380, p=0.614). Conclusions: TEVAR is a safe and effective procedure with excellent long-term results for traumatic aortic injury. However, overall long-term survival is reduced, particularly for patients with type A aortic dissection and aneurysmatic aortic disease. Futher study should address the role of comorbidity in long-term survival. LEGEND Figure 1. Long-term survival of TEVAR stratified by specific aortic pathologies.