Risk factors of mortality in different age groups after thoracic endovascular aortic repair.
BACKGROUND
The aim of this study was to determine risk factors for mortality in different age groups after thoracic endovascular aortic repair (TEVAR).


METHODS
We retrospectively analyzed 226 consecutive patients undergoing TEVAR at our institution during a 12-year period (female 28%; median age 67 years). Fifty-six patients were more than 75 years of age at the time of TEVAR. Follow-up data were available in all patients.


RESULTS
Patients more than 75 years old had a higher incidence of extracardiac arteriopathy (79% versus 58%; p = 0.006) and were more likely to be unsuitable for open surgery (84% versus 47%; p < 0.001). Multivariate logistic regression analysis revealed the combined endpoint of perioperative myocardial infarction and neurologic injury (p = 0.023, odds ratio 13.9, 95% confidence interval: 1.44 to 134.6) as well as persisting type I and III endovascular leaks (p = 0.042, odds ratio 2.81, 95% confidence interval: 1.04 to 7.58) as independent predictors of mortality in patients less than 75 years old. Emergency TEVAR was the only independent predictor of mortality among patients more than 75 years old (p = 0.041, odds ratio 3.65, 95% confidence interval: 1.06 to 12.64).


CONCLUSIONS
Different age groups exhibit different risk factors after TEVAR. The prognosis for younger patients is substantially limited by perioperative myocardial infarction and neurologic injury as well as persisting endovascular leak formation, as these patients may be more likely to experience aortic-related complications. Emergency TEVAR-most often being associated with hemodynamic instability-is the limiting factor for elderly patients, reflecting their frail physiology. Adhering to strict indications and broad screening, thereby reducing the incidence of emergency procedures, will help to further improve outcome after TEVAR.
Czerny
Martin
M
Department of Cardiovascular Surgery, University Hospital Berne, Berne, Switzerland.
Funovics
Martin
M
Ehrlich
Marek
M
Hoebartner
Michael
M
Sodeck
Gottfried
G
Dumfarth
Julia
J
Schoder
Maria
M
Juraszek
Andrzej
A
Dziodzio
Tomasz
T
Loewe
Christian
C
Zimpfer
Daniel
D
Reineke
David
D
Grimm
Michael
M
D000367:Age Factors; D000368:Aged; D001013:Aorta, Thoracic / Q000601:surgery*; D001018:Aortic Diseases / Q000401:mortality* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D019616:Thoracic Surgical Procedures / Q000009:adverse effects / Q000379:methods; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000379:methods