Improved midterm outcomes after endovascular repair of nontraumatic descending thoracic aortic rupture compared with open surgery.

Abstract

BACKGROUND\nThoracic endovascular aortic repair (TEVAR) has become first-line treatment for descending thoracic aortic rupture (DTAR), but its midterm and long-term outcomes remain undescribed. This study evaluated whether TEVAR would improve midterm outcomes of nontraumatic DTAR relative to open surgical repair (OSR).\n\n\nMETHODS\nBetween December 1999 and October 2018, 118 patients with DTAR were treated with either OSR (n\xa0=\xa039) or TEVAR (n\xa0=\xa079) at a single center. Primary end points were 30-day and long-term all-cause mortalities. Secondary end points included stroke, permanent spinal cord ischemia (SCI), prolonged ventilation support or tracheostomy, permanent hemodialysis, and aortic reintervention.\n\n\nRESULTS\nThirty-day mortality was significantly lower with TEVAR (OSR, 38.5%; TEVAR, 16.5%; P\xa0=\xa0.01). Stroke (15.6% vs 3.8%; P\xa0=\xa0.03), permanent SCI (15.6% vs 2.5%; P\xa0=\xa0.02), prolonged ventilation (30.8% vs 8.9%; P\xa0=\xa0.002), and tracheostomy (12.8% vs 2.5%; P\xa0=\xa0.04) were significantly lower after TEVAR than OSR. Need for hemodialysis trended higher after OSR (12.8% vs 5.1%; P\xa0=\xa0.2). Mean follow ups were 1048\xa0±\xa01591\xa0days for OSR group and 828\xa0±\xa01258\xa0days for TEVAR. All-cause mortality at last follow-up was significantly lower after TEVAR than OSR (35.4% vs 66.7%; P\xa0=\xa0.001). Aortic reintervention was required more frequently within 30\xa0days after TEVAR (15.2% vs 2.6%; P\xa0=\xa0.06). By multivariate analysis, TAAA was an independent predictor for mortality.\n\n\nCONCLUSIONS\nTEVAR improves both early and midterm outcomes of DTAR relative to OSR. TAAA was a predictor of mortality. Endovascular approach to DTAR may provide the greatest chance at survival.