Investigation of the surgical complications during thoracic endovascular aortic repair: experiences with 148 consecutive cases treated at a single institution in Japan.
OBJECTIVE
To investigate the risk factors associated with thoracic endovascular aortic repair at The Sakakibara Heart Institute of Okayama in Japan.


METHODS
A total of 148 consecutive patients who underwent thoracic endovascular aortic repair between November 2009 and October 2012 were investigated.


RESULTS
The patients' mean age at the time of the operation was 72.8 ± 11.7 years. The initial success rate of the procedure was 92.6 %. The 30-day mortality rate was 3.4 %, and the multivariable risk factors for mortality were urgent/emergency surgery and a sternotomy approach. The incidence of permanent stroke was 3.4 %. The multivariable risk factors for stroke included an age over 70 years and cases requiring the debranching procedure. The rate of paraplegia/paraparesis was 5.4 %. The mean follow-up was 14.8 ± 9.2 months, and the follow-up rate was 97.3 %. The overall mortality rate was 12.8 %. The survival rates after thoracic endovascular repair were 88.3 % in the first year, 87.0 % in the second year and 69.6 % in the third year. The freedom from aorta-related death rate was 97.1 % at 3 years. Primary technical success was a strong negative predictor of aorta-related death.


CONCLUSIONS
The use of a debranching technique and sternotomy approach in patients with extensive atherosclerotic changes of the aortic arch were risk factors for major complications of TEVAR. Such patients may benefit from open surgery rather than TEVAR.
Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, 2-5-1 Nakaichou, Kita-ku, Okayama, 700-0804, Japan, kochin0726@yahoo.co.jp.
Koyu
K
Tanaka
Hidenori
H
Yoshitaka
Genta
G
Chikazawa
Taichi
T
Sakaguchi
Toshinori
T
Totsugawa
Kentaro
K
Tamura
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D004630:Emergencies; D057510:Endovascular Procedures / Q000379:methods* / Q000401:mortality; D005260:Female; D006801:Humans; D015994:Incidence; D007564:Japan; D008297:Male; D008875:Middle Aged; D010264:Paraplegia / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology*; D012307:Risk Factors; D056346:Sternotomy / Q000009:adverse effects; D020521:Stroke / Q000453:epidemiology; D013534:Survival; D013997:Time Factors