Emergent repair of acute thoracic aortic catastrophes: A comparative analysis

Objective: To provide a contemporary institutional comparative analysis of expedient correction of acute catastrophes of the descending thoracic aorta (ACDTA) by traditional direct thoracic aortic repair (DTAR) or thoracic endovascular aortic repair (TEVAR). Design: Single-center retrospective review (April 2001-January 2010). Setting: Academic medical center. Patients: One hundred patients with ACDTA treated with either TEVAR (n=76) or DTAR (n=24). Indications for repair included ruptured degenerative aneurysm (n=41), traumatic transection (n=27), complicated acute type B dissection (n=20), penetrating ulcer (n=4), intramural hematoma (n=3), penetrating injury (n=3), and embolizing lesion (n=2). Main Outcome Measures: Demographics and 30-day and late outcomes were analyzed using multivariate analysis over a mean follow-up of 33.8 months. Results: Among the 100 patients, mean (SD) age was 58.5 (17.3) years (range, 18-87 years). Demographics and comorbid conditions were similar between the 2 groups, except more patients in the DTAR group had prior aortic surgery (P=.02) and were older (P=.01). Overall 30-day mortality was significantly better among the TEVAR group (8% vs 29%; P=.007). Incidence of postoperative myocardial infarction, acute renal failure, stroke, and paraplegia/paresis was similar between the 2 treatment groups (TEVAR, 5%, 12%, 8%, and 8% vs DTAR, 13%, 13%, 9%, and 13%, respectively). Major respiratory complications were lower in the TEVAR group (16% vs 48%; P<.05). Mean length of hospital stay was also shorter after TEVAR (13.5 vs 16.3 days; P=.30). Independent predictors of patient mortality included age (P=.004) and DTAR (P=.001). Conclusion: Patients presenting with ACDTA are best treated with TEVAR whenever feasible.