TY - JOUR
T1 - Outcomes of Open Versus Endovascular Repair of Descending Thoracic and Thoracoabdominal Aortic Aneurysms
AU - Tong, Michael Z.
AU - Eagleton, Matthew J.
AU - Roselli, Eric E.
AU - Blackstone, Eugene H.
AU - Xiang, Fei
AU - Ibrahim, Mudathir
AU - Johnston, Douglas R.
AU - Soltesz, Edward G.
AU - Bakaeen, Faisal G.
AU - Lyden, Sean P.
AU - Toth, Andrew J.
AU - Liu, Huan
AU - Svensson, Lars G.
N1 - Funding Information:
The authors wish to acknowledge the contributions of Drs Dean Schraufnagel, Behzad Farivar, Milind Desai, and Donald Hammer, and the Cleveland Clinic Aorta Center, and thank Capri Spencer, Tanya Ashinhurst, Tess Parry, Allison Siegel, and their Clinical Investigations team for their support. Funding for this work was provided by the Cleveland Clinic Department of Thoracic and Cardiovascular Surgery and the Drs Sidney and Becca Fleischer Heart and Vascular Education Chair.
Funding Information:
The authors wish to acknowledge the contributions of Drs Dean Schraufnagel, Behzad Farivar, Milind Desai, and Donald Hammer, and the Cleveland Clinic Aorta Center, and thank Capri Spencer, Tanya Ashinhurst, Tess Parry, Allison Siegel, and their Clinical Investigations team for their support. Funding for this work was provided by the Cleveland Clinic Department of Thoracic and Cardiovascular Surgery and the Drs Sidney and Becca Fleischer Heart and Vascular Education Chair.
Publisher Copyright:
© 2022 The Society of Thoracic Surgeons
PY - 2022/4
Y1 - 2022/4
N2 - Background: Open repair is the standard of care for patients with descending thoracic and thoracoabdominal aortic aneurysms. Although effective, surgery carries a high risk of morbidity and mortality. Endovascular stent grafts were introduced to treat these aneurysms in patients considered too high risk for open repair. Early results are promising, but later results are incompletely known. Therefore, we sought to compare short- and intermediate-term outcomes of open vs endovascular repair for these aneurysms. Methods: From 2000 to 2010, 1053 patients underwent open (n = 457) or endovascular (n = 596) repair of descending thoracic and thoracoabdominal aortic aneurysms at Cleveland Clinic. To balance patient characteristics between these groups, propensity score matching was performed, yielding 278 well-matched pairs (61% of possible pairs). End points included short- and long-term outcomes. Results: In matched patients, compared with endovascular stenting, open repair achieved similar in-hospital death (n = 23 [8.3%] vs n = 21 [7.6%], P = .80) and occurrence of paralysis and stroke (n = 10 [3.6%] vs n = 6 [2.2%], P = .30), despite a longer postoperative stay (median 11 vs 6 days), more dialysis-dependent acute renal failure (n = 24 [8.6%] vs n = 9 [3.3%], P = .008), and prolonged ventilation (n = 106 [46%] vs n = 17 [6.3%], P < .0001). Open repair resulted in better 10-year survival than endovascular repair (52% vs 33%, P < .0001), and aortic reintervention was less frequent (4% vs 21%, P < .0001). Despite a decrease in the first postoperative year, average aneurysm size did not recover to normal range after endovascular stenting. Conclusions: Open repair of descending thoracic and thoracoabdominal aneurysms can achieve acceptable short-term outcomes with better intermediate-term outcomes than endovascular repair.
AB - Background: Open repair is the standard of care for patients with descending thoracic and thoracoabdominal aortic aneurysms. Although effective, surgery carries a high risk of morbidity and mortality. Endovascular stent grafts were introduced to treat these aneurysms in patients considered too high risk for open repair. Early results are promising, but later results are incompletely known. Therefore, we sought to compare short- and intermediate-term outcomes of open vs endovascular repair for these aneurysms. Methods: From 2000 to 2010, 1053 patients underwent open (n = 457) or endovascular (n = 596) repair of descending thoracic and thoracoabdominal aortic aneurysms at Cleveland Clinic. To balance patient characteristics between these groups, propensity score matching was performed, yielding 278 well-matched pairs (61% of possible pairs). End points included short- and long-term outcomes. Results: In matched patients, compared with endovascular stenting, open repair achieved similar in-hospital death (n = 23 [8.3%] vs n = 21 [7.6%], P = .80) and occurrence of paralysis and stroke (n = 10 [3.6%] vs n = 6 [2.2%], P = .30), despite a longer postoperative stay (median 11 vs 6 days), more dialysis-dependent acute renal failure (n = 24 [8.6%] vs n = 9 [3.3%], P = .008), and prolonged ventilation (n = 106 [46%] vs n = 17 [6.3%], P < .0001). Open repair resulted in better 10-year survival than endovascular repair (52% vs 33%, P < .0001), and aortic reintervention was less frequent (4% vs 21%, P < .0001). Despite a decrease in the first postoperative year, average aneurysm size did not recover to normal range after endovascular stenting. Conclusions: Open repair of descending thoracic and thoracoabdominal aneurysms can achieve acceptable short-term outcomes with better intermediate-term outcomes than endovascular repair.
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U2 - 10.1016/j.athoracsur.2021.04.100
DO - 10.1016/j.athoracsur.2021.04.100
M3 - Article
C2 - 34048754
AN - SCOPUS:85118559604
SN - 0003-4975
VL - 113
SP - 1144
EP - 1152
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 4
ER -