title: Risk factors of mortality in different age groups after thoracic endovascular aortic repair.
abstract: 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.
authors.affiliation: Department of Cardiovascular Surgery, University Hospital Berne, Berne, Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Czerny
authors.forename: Martin
authors.initials: M
authors.lastname: Funovics
authors.forename: Marek
authors.initials: M
authors.lastname: Ehrlich
authors.forename: Michael
authors.initials: M
authors.lastname: Hoebartner
authors.forename: Gottfried
authors.initials: G
authors.lastname: Sodeck
authors.forename: Julia
authors.initials: J
authors.lastname: Dumfarth
authors.forename: Maria
authors.initials: M
authors.lastname: Schoder
authors.forename: Andrzej
authors.initials: A
authors.lastname: Juraszek
authors.forename: Tomasz
authors.initials: T
authors.lastname: Dziodzio
authors.forename: Christian
authors.initials: C
authors.lastname: Loewe
authors.forename: Daniel
authors.initials: D
authors.lastname: Zimpfer
authors.forename: David
authors.initials: D
authors.lastname: Reineke
authors.forename: Michael
authors.initials: M
authors.lastname: Grimm
mesh_terms: 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