Risk factors for late mortality after endovascular repair of the thoracic aorta.
OBJECTIVE
This study was conducted to identify risk factors for late mortality after thoracic endovascular aortic repair (TEVAR).


METHODS
A retrospective analysis of consecutive TEVAR was conducted. Medical record review, telephone contact, or query of the Social Security Death Index was used to determine 30-day and late survival. Late mortality was assessed with respect to patient characteristics at the time of the initial treatment, preoperative laboratory values, pathology, clinical presentation, and treatment adjuncts. Significant univariate predictors of death were entered into a multivariate Cox proportional hazards model.


RESULTS
From 1998 to 2009, 252 patients (149 men; mean age, 68 years) underwent TEVAR for degenerative thoracic aortic aneurysm (TAA, n = 143), type B dissection (n = 62), mycotic aneurysm (n = 13), traumatic disruption (n = 12), penetrating ulcer or intramural hematoma (n = 10), anastomotic pseudoaneurysm (n = 4), or other pathology (n = 8). The 30-day mortality was 9.5%, with stroke or spinal cord injury in 5.6%. Mean follow-up was 22 +/- 22 months. Kaplan-Meier mean survival was 53 months. Predictors of late mortality by univariate analysis included age (P < .01), cardiac arrhythmia (P = .03), chronic obstructive pulmonary disease (P = .05), aneurysm diameter (P < .01), rupture (P < .01), debranching (P = .02), leukocytosis (white blood cell count > 10.0 x 10(3)/microL; P < .01), albumin, (P < .01), and creatinine > 1.7 mg/dL (P = .01). Multivariate predictors of mortality included rupture (hazard ratio [HR], 3.10; 95% confidence interval [CI], 1.02-9.44; P = .03), debranching (HR, 2.20; 95% CI, 1.09-4.24; P = .03), preoperative leukocytosis (HR, 1.23; 95% CI, 1.09-1.39; P = .001), and aneurysm diameter (HR, 1.02; 95% CI, 1.01-1.03; P = .04). Subgroup analysis of patients undergoing TEVAR for asymptomatic, nonruptured TAA demonstrated that debranching (HR, 2.47; 95% CI, 1.13-5.39; P = .02), White blood cell count (HR, 1.19; 95% CI, 1.01-1.40; P < .04), and aneurysm diameter (HR, 1.03; 95% CI, 1.01-1.05, P < .01) remain independently predictive of late mortality.


CONCLUSIONS
Preoperative leukocytosis, aneurysm diameter, and concurrent debranching independently predict late mortality irrespective of clinical presentation and may assist in risk stratification.
Chung
Jayer
J
Division of Vascular Surgery and Endovascular Therapy, Emory University, Atlanta, GA 30322, USA.
Corriere
Matthew A
MA
Veeraswamy
Ravi K
RK
Kasirajan
Karthikeshwar
K
Milner
Ross
R
Dodson
Thomas F
TF
Salam
Atef A
AA
Chaikof
Elliot L
EL
D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery; D017541:Aneurysm, False / Q000401:mortality / Q000601:surgery; D000785:Aneurysm, Infected / Q000401:mortality / Q000601:surgery; D001013:Aorta, Thoracic / Q000293:injuries / Q000473:pathology / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000601:surgery; D001018:Aortic Diseases / Q000097:blood / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality*; D015897:Comorbidity; D005260:Female; D005845:Georgia / Q000453:epidemiology; D006406:Hematoma / Q000401:mortality / Q000601:surgery; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D007958:Leukocyte Count; D007964:Leukocytosis / Q000097:blood / Q000401:mortality; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014456:Ulcer / Q000401:mortality / Q000601:surgery