Risk factors for 1-year mortality after thoracic endovascular aortic repair

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 145; no. 5; pp. 1242 - 1247
• Main Authors: Shah, Asad A., MD, Craig, Damian M., MA, Andersen, Nicholas D., MD, Williams, Judson B., MD, Bhattacharya, Syamal D., MD, Shah, Svati H., MD, MHS, McCann, Richard L., MD, Hughes, G. Chad, MD
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01.05.2013
• Subjects: Aged; Aorta, Thoracic - surgery; Aortic Diseases - mortality; Aortic Diseases - surgery; Blood Vessel Prosthesis Implantation - adverse effects; Blood Vessel Prosthesis Implantation - mortality; Cardiothoracic Surgery; Chi-Square Distribution; Endovascular Procedures - adverse effects; Endovascular Procedures - mortality; Female; Hospital Mortality; Humans; Linear Models; Male; Multivariate Analysis; North Carolina - epidemiology; Postoperative Complications - mortality; Proportional Hazards Models; Retrospective Studies; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome; North Carolina; 26.1; thoracic endovascular aortic repair; EVAR; TEVAR; American Society of Anesthesiologists; 26.1.3; endovascular abdominal aortic aneurysm repair; ASA
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2012.05.005

Objective Thoracic endovascular aortic repair, although physiologically well tolerated, may fail to confer significant survival benefit in some high-risk patients. In an effort to identify patients most likely to benefit from intervention, the present study sought to determine the risk factors for 1-year mortality after thoracic endovascular aortic repair. Methods A retrospective review was performed on prospectively collected data from all patients undergoing thoracic endovascular aortic repair from 2002 to 2010 at a single institution. Univariate analysis and multivariate Cox proportional hazards regression analysis were used to identify risk factors associated with mortality within 1 year after thoracic endovascular aortic repair. Results During the study period, 282 patients underwent at least 1 thoracic endovascular aortic repair; index procedures included descending aortic repair (n = 189), hybrid arch repair (n = 55), and hybrid thoracoabdominal repair (n = 38). The 30-day/in-hospital mortality was 7.4% (n = 21) and the overall 1-year mortality was 19% (n = 54). Cardiopulmonary pathologies were the most common cause of nonperioperative 1-year mortality (22%, n = 12). Multivariate modeling demonstrated 3 variables independently associated with 1-year mortality: age older than 75 years (hazard ratio, 2.26; P  = .005), aortic diameter greater than 6.5 cm (hazard ratio, 2.20; P  = .007), and American Society of Anesthesiologists class 4 (hazard ratio, 1.85; P  = .049). A baseline creatinine greater than 1.5 mg/dL (hazard ratio, 1.79; P  = .05) and congestive heart failure (hazard ratio, 1.87; P  = .08) were also retained in the final model. These 5 variables explained a large proportion of the risk of 1-year mortality (C statistic = 0.74). Conclusions Age older than 75 years, aortic diameter greater than 6.5 cm, and American Society of Anesthesiologists class 4 are independently associated with 1-year mortality after thoracic endovascular aortic repair. These clinical characteristics may help risk-stratify patients undergoing thoracic endovascular aortic repair and identify those unlikely to derive a long-term survival benefit from the procedure.