Impact of age and urgency on survival after thoracic endovascular aortic repair.
OBJECTIVE
Elderly patients are often turned down from receiving treatment for descending thoracic aortic diseases (DTADs) because of the uncertain benefits, especially in acute settings. This study investigated the impact of old age and timing of thoracic endovascular aortic repair (TEVAR) on outcomes of DTAD in patients older than 75 years of age.


METHODS
Patients from a prospective TEVAR database were dichotomized by age (75 and 80 years of age). Older and young patients were compared in three timing scenarios: (1) elective procedures, (2) any emergency (within 15 days from onset), and (3) acute ruptures (any emergency subgroup). Primary outcome was perioperative mortality assessed at 30 and 90 days.


RESULTS
Between 2003 and 2015, 141 consecutive TEVARs (71.6% men) were performed. Fifty-seven patients (40.4%) were older than 75 years of age; 28 were octogenarians. Eighty-three TEVARs were performed electively and 58 emergently. Among overall emergencies, 42 TEVARs were for acute ruptures. In the elective scenario, the 30-day mortality rate was 5.0% vs 0 (odds ratio [OR], 1.1; 95% confidence interval [CI], 0.98-1.1; P = .23), and 90-day mortality was 7.5% vs 0, for patients older than 75 years of age vs those who were younger than 75, respectively (P = .11). No octogenarian died. In the emergency scenario, 30-day mortality was 41.2% vs 9.8%, for patients older than 75 years of age vs those who were younger than 75, respectively (OR, 6.5; 95% CI, 1.6-26.6; P = .01) with unchanged rates at 90 days. The mortality rate was 50% for octogenarians. In the acute rupture scenario, 30-day mortality was 40% vs 11.1% (OR, 5.3; 95% CI, 1.10-25.99; P = .05) for patients older than 75 years of age vs those younger than 75 years of age and 46% vs 10% (OR, 7.5; 95% CI, 1.47-37.46; P = .016) for octogenarians vs younger patients. Rates remained unchanged at 90 days. Patients older than age 75 survived for a mean of 53.98 ± 7.7 months after TEVAR.


CONCLUSIONS
In the elderly patient population with DTAD, mortality risks from TEVAR are strongly related to timing and age. When compared to younger patients, those older than 75 years of age have three to five times the risk of mortality after urgent or emergent TEVAR. However, older patients should still be considered for emergent life-saving treatment, given that the majority survives.
Department of Vascular and Endovascular Surgery, Hospital S. M. Misericordia, University of Perugia, Perugia, Italy. Electronic address: plderango@gmail.com.
Paola
P
De Rango
Department of Vascular and Endovascular Surgery, Hospital S. M. Misericordia, University of Perugia, Perugia, Italy.
Giacomo
G
Isernia
Department of Vascular and Endovascular Surgery, Hospital S. M. Misericordia, University of Perugia, Perugia, Italy.
Gioele
G
Simonte
Department of Vascular and Endovascular Surgery, Hospital S. M. Misericordia, University of Perugia, Perugia, Italy.
Enrico
E
Cieri
Department of Vascular and Endovascular Surgery, Hospital S. M. Misericordia, University of Perugia, Perugia, Italy.
Alessandro
A
Marucchini
Department of Vascular and Endovascular Surgery, Hospital S. M. Misericordia, University of Perugia, Perugia, Italy.
Luca
L
Farchioni
Department of Vascular and Endovascular Surgery, Hospital S. M. Misericordia, University of Perugia, Perugia, Italy.
Fabio
F
Verzini
Department of Vascular and Endovascular Surgery, Hospital S. M. Misericordia, University of Perugia, Perugia, Italy.
Massimo
M
Lenti
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001019:Aortic Rupture / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D016009:Chi-Square Distribution; D016208:Databases, Factual; D017558:Elective Surgical Procedures; D004630:Emergencies; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D018579:Patient Selection; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult