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Thoracic Endovascular Aortic Repair (TEVAR): Evolution of Therapy, Patterns of Use and Results in 450 Cases
*Joseph Bavaria, Alberto Pochettino, Wilson Szeto, G. William Moser, Patrick J Moeller, Nimesh Desai, Nishtha Sodhi, Benjamin Jackson, Edward Woo, Ron Fairman
Hospital of the University of Pennsylvania, Philadelphia, PA
BACKGROUND:The introduction of aortic stent grafting in the treatment of thoracic aortic disease has pioneered unique treatment options and has gained rapid clinical adoption despite a paucity of long-term outcome data. The purpose of this analysis is to examine all operations performed using thoracic aortic stent grafts at our institution.
METHODS:450 operations involving TEVAR were performed from April 1999 until September 2008. Patients were followed in a prospectively collected clinical perioperative registry, and long term outcomes were determined from administrative data sources. Aortic pathologies include aortic aneurysm, acute aortic dissection (type A and B), hybrid arch repairs, reinterventions with additional stents, pseudoaneurysm, chronic type B dissection, traumatic transection, penetrating aortic ulcer, and other unique indications (including ascending aneurysm).
RESULTS:The mean patient age was 70.1 +/- 12.6 years and 39.2%(n=177) were females. Post-operative neurological complications included: permanent paraplegia in 3.54%(n=16), permanent stroke in 4.2%(n=19), and reversible spinal cord ischemia in 5.3%(n=24). Post-operative onset of new hemodialysis occurred in 2.8% of operations (n=13). Overall 30 day mortality was 8.7%(n=39). Long term all-cause mortality data was collected for all patients (table 1).
CONCLUSIONS:Thoracic aortic stent grafting has evolved to be a viable option to complement, augment, or replace traditional treatments for aortic disease. This study illustrates the applicability of this technology in the establishment of new treatment paradigms for the entire spectrum complex aortic pathologies.
In-Hospital Mortality and Survival| Classification | N | In-hospital Mortality | Permanent Paraplegia | Transient (Reversed) Paraplegia | 1 year Survival (N entering interval) | 3 Year Survival (N entering interval) | 5 Year Survival (N entering interval) | 8 Year Survival (N entering interval) | | Aneurysm | 279 | 8.2% | 3.5% | 4.3% | 83% (197) | 72% (98) | 64% (32) | 61% (11) | | Acute Aortic Dissection (A/B) | 76 | 3.9% | 2.6% | 9.2% | 88% (59) | 88% (14) | | | | Arch Hybrid | 23 | 13% | 13% | 8.5% | 57% (7) | 57% (3) | | | | Reinterventions in Stented Patients | 19 | 5.3% | 0% | 0% | 89% (15) | 56% (4) | 56% (3) | | | Pseudoaneurysm | 14 | 0% | 0% | 7.1% | 85% (10) | 51% (6) | | | | Chronic Type B Dissection | 13 | 0% | 0% | 15.4% | 100% (10) | 100% (1) | | | | Traumatic Transection | 13 | 23.1% | 7.7% | 0% | 76% (9) | 76% (1) | | | | PAU | 7 | 0% | 0% | 0% | 42% (3) | | | | | Unique Indications | 6 | 16.7% | 16.7% | 0% | 60% (2) | | | |
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