Background: This study identified risk factors for late mortality after thoracic endovascular aortic repair (TEVAR). Methods: A retrospective analysis of a prospectively maintained database of consecutive TEVAR was conducted. Thirty-day and late survival was determined by medical record review, telephone contact, or query of the Social Security Death Index. Late mortality was assessed with respect to patient characteristics at the time of initial treatment (ages, gender, pulmonary, cardiac and renal disease, hypertension, hyperlipidemia, diabetes, medication) preoperative laboratory values (albumin, hemoglobin, (Figure presented) white blood cell [WBC] count, platelet count, creatinine), pathology (aneurysm type, diameter), clinical presentation (symptomatic, rupture), and treatment adjuncts (debranching). Variables significant by univariate analysis were entered into a multivariate Cox regression model to ascertain independent predictors of mortality. Results: From 1998 and 2009, 252 patients (149 men; median age, 70 years) underwent TEVAR. Indications were degenerative thoracic aortic aneurysm (TAA) in 143, type B dissection in 62, mycotic aneurysm in 13, traumatic disruption in 12, penetrating ulcer/intramural hematoma in 10, anastomotic pseudoaneurysm in 4, or other pathology in 8. The 30-day mortality was 9.5%, with stroke or spinal cord injury in 5.6%. Mean (plus or minus) SD follow-up was 22 (plus or minus) 22 months, with a Kaplan-Meier mean survival of 53 months. Predominant causes of late death were cardiac disease, malignancy, and chronic obstructive pulmonary disease (COPD). Predictors of late death by univariate analysis included age (P < .01), cardiac arrhythmia (P - .03), COPD (P - .05), hyperlipidemia (P - .03), statin use (P - .02), aneurysm diameter (P < .01), rupture, and elevated creatinine (P - 01). Multivariate analysis revealed that rupture (hazard ratio [HR] 3.1; 95% confidence interval [CI], 1.02-9.44; P - 03), debranching (HR, 2.20; 95% CI, 1.09- 4.24; P-.03), preoperative WBC count (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) were independent predictors of late mortality. Subgroup analysis of patients undergoing elective TEVAR for asymptomatic, nonruptured TAA demonstrated that debranching (HR, 2.47; 95% CI, 1.13-5.39; P - .02), WBC 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 (Fig 1). Conclusions: Despite adequate initial repair, long-term survival after TEVAR remains compromised. Concurrent debranching, preoperative WBC count, and aneurysm diameter independently predict late mortality irrespective of clinical presentation and may assist in risk stratification.
Chung, J., Kasirajan, K., Veeraswamy, R., Corriere, M., Dodson, T., Milner, R., … Chaikof, E. L. (2009). Risk Factors for Late Mortality Following Endovascular Thoracic Aneurysm Repair. Journal of Vascular Surgery, 50(6), 1538. https://doi.org/10.1016/j.jvs.2009.10.018