Cohort Comparison of Thoracic Endovascular Aortic Repair with Open Thoracic Aortic Repair Using Modern End-Organ Preservation Strategies

Dean J. Arnaoutakis, George J. Arnaoutakis, Christopher Joseph Abularrage, Robert J. Beaulieu, Ashish S. Shah, Duke E. Cameron, James Hamilton Black

Research output: Contribution to journalArticle

Abstract

Background: Pivotal trials showed that thoracic endovascular aortic repair (TEVAR) has improved outcomes compared with open surgery for treating descending thoracic aortic aneurysms. However, those trials included historical open controls in which modern end-organ preservation strategies were not routinely employed. To create a more level assessment, we compared our outcomes of elective TEVAR with modern open thoracic aortic repair (OTAR) controls. Methods: A retrospective review of thoracic aortic aneurysm patients undergoing TEVAR was compared with a contemporaneous cohort of OTAR patients. Partial bypass or hypothermic circulatory arrest was used in all OTAR patients. Cerebrospinal fluid drain placement was attempted in all patients. Preoperative characteristics, operative variables, and outcomes were recorded, and the Kaplan-Meier method was used for survival estimates. Results: The main outcome was mortality. Secondary outcomes included postoperative spinal cord ischemia (SCI) or stroke, and any persistent neurologic deficit 30 days following the operation. During the study period, 62 patients underwent TEVAR and 56 underwent OTAR with median follow-up of 23.7 months and 36.4 months, respectively. No difference existed between the TEVAR and OTAR with respect to overall neurologic complications (8.1% vs. 12.5%, P = 0.55) as well as any residual neurologic deficit at 30 days (0% vs. 5.4%, P = 0.10). TEVAR patients had fewer complications including pneumonia (P = 0.02), rebleeding (P = 0.02), and acute kidney injury (P = 0.001). There was no difference in 30-day mortality (1.6% vs. 8.9%, P = 0.10), 1-year mortality (12.2% vs. 14%, P = 0.80), or 5-year mortality (53.9% vs. 44%, P = 0.48) between TEVAR and OTAR, respectively. Conclusions: TEVAR continues to show improved perioperative outcomes with a trend toward decreased 30-day mortality and fewer major adverse events compared with OTAR. However, with the routine use of end-organ preservation strategies during OTAR, neurologic deficits, particularly SCI, can be safely reduced to comparable levels with those of TEVAR and 1-year all-cause mortality rates are similar between the groups. These OTAR results may serve as a benchmark as TEVAR is increasingly applied for other aortic pathologies, such as chronic dissection, wherein long-term efficacy is not proven.

Original languageEnglish (US)
Pages (from-to)882-890
Number of pages9
JournalAnnals of Vascular Surgery
Volume29
Issue number5
DOIs
StatePublished - Jul 1 2015

Fingerprint

Organ Preservation
Thorax
Mortality
Neurologic Manifestations
Spinal Cord Ischemia
Thoracic Aortic Aneurysm
Benchmarking

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Cohort Comparison of Thoracic Endovascular Aortic Repair with Open Thoracic Aortic Repair Using Modern End-Organ Preservation Strategies. / Arnaoutakis, Dean J.; Arnaoutakis, George J.; Abularrage, Christopher Joseph; Beaulieu, Robert J.; Shah, Ashish S.; Cameron, Duke E.; Black, James Hamilton.

In: Annals of Vascular Surgery, Vol. 29, No. 5, 01.07.2015, p. 882-890.

Research output: Contribution to journalArticle

Arnaoutakis, Dean J. ; Arnaoutakis, George J. ; Abularrage, Christopher Joseph ; Beaulieu, Robert J. ; Shah, Ashish S. ; Cameron, Duke E. ; Black, James Hamilton. / Cohort Comparison of Thoracic Endovascular Aortic Repair with Open Thoracic Aortic Repair Using Modern End-Organ Preservation Strategies. In: Annals of Vascular Surgery. 2015 ; Vol. 29, No. 5. pp. 882-890.
@article{48215314957a4fbeae83af7515746950,
title = "Cohort Comparison of Thoracic Endovascular Aortic Repair with Open Thoracic Aortic Repair Using Modern End-Organ Preservation Strategies",
abstract = "Background: Pivotal trials showed that thoracic endovascular aortic repair (TEVAR) has improved outcomes compared with open surgery for treating descending thoracic aortic aneurysms. However, those trials included historical open controls in which modern end-organ preservation strategies were not routinely employed. To create a more level assessment, we compared our outcomes of elective TEVAR with modern open thoracic aortic repair (OTAR) controls. Methods: A retrospective review of thoracic aortic aneurysm patients undergoing TEVAR was compared with a contemporaneous cohort of OTAR patients. Partial bypass or hypothermic circulatory arrest was used in all OTAR patients. Cerebrospinal fluid drain placement was attempted in all patients. Preoperative characteristics, operative variables, and outcomes were recorded, and the Kaplan-Meier method was used for survival estimates. Results: The main outcome was mortality. Secondary outcomes included postoperative spinal cord ischemia (SCI) or stroke, and any persistent neurologic deficit 30 days following the operation. During the study period, 62 patients underwent TEVAR and 56 underwent OTAR with median follow-up of 23.7 months and 36.4 months, respectively. No difference existed between the TEVAR and OTAR with respect to overall neurologic complications (8.1{\%} vs. 12.5{\%}, P = 0.55) as well as any residual neurologic deficit at 30 days (0{\%} vs. 5.4{\%}, P = 0.10). TEVAR patients had fewer complications including pneumonia (P = 0.02), rebleeding (P = 0.02), and acute kidney injury (P = 0.001). There was no difference in 30-day mortality (1.6{\%} vs. 8.9{\%}, P = 0.10), 1-year mortality (12.2{\%} vs. 14{\%}, P = 0.80), or 5-year mortality (53.9{\%} vs. 44{\%}, P = 0.48) between TEVAR and OTAR, respectively. Conclusions: TEVAR continues to show improved perioperative outcomes with a trend toward decreased 30-day mortality and fewer major adverse events compared with OTAR. However, with the routine use of end-organ preservation strategies during OTAR, neurologic deficits, particularly SCI, can be safely reduced to comparable levels with those of TEVAR and 1-year all-cause mortality rates are similar between the groups. These OTAR results may serve as a benchmark as TEVAR is increasingly applied for other aortic pathologies, such as chronic dissection, wherein long-term efficacy is not proven.",
author = "Arnaoutakis, {Dean J.} and Arnaoutakis, {George J.} and Abularrage, {Christopher Joseph} and Beaulieu, {Robert J.} and Shah, {Ashish S.} and Cameron, {Duke E.} and Black, {James Hamilton}",
year = "2015",
month = "7",
day = "1",
doi = "10.1016/j.avsg.2015.01.007",
language = "English (US)",
volume = "29",
pages = "882--890",
journal = "Annals of Vascular Surgery",
issn = "0890-5096",
publisher = "Elsevier Inc.",
number = "5",

}

TY - JOUR

T1 - Cohort Comparison of Thoracic Endovascular Aortic Repair with Open Thoracic Aortic Repair Using Modern End-Organ Preservation Strategies

AU - Arnaoutakis, Dean J.

AU - Arnaoutakis, George J.

AU - Abularrage, Christopher Joseph

AU - Beaulieu, Robert J.

AU - Shah, Ashish S.

AU - Cameron, Duke E.

AU - Black, James Hamilton

PY - 2015/7/1

Y1 - 2015/7/1

N2 - Background: Pivotal trials showed that thoracic endovascular aortic repair (TEVAR) has improved outcomes compared with open surgery for treating descending thoracic aortic aneurysms. However, those trials included historical open controls in which modern end-organ preservation strategies were not routinely employed. To create a more level assessment, we compared our outcomes of elective TEVAR with modern open thoracic aortic repair (OTAR) controls. Methods: A retrospective review of thoracic aortic aneurysm patients undergoing TEVAR was compared with a contemporaneous cohort of OTAR patients. Partial bypass or hypothermic circulatory arrest was used in all OTAR patients. Cerebrospinal fluid drain placement was attempted in all patients. Preoperative characteristics, operative variables, and outcomes were recorded, and the Kaplan-Meier method was used for survival estimates. Results: The main outcome was mortality. Secondary outcomes included postoperative spinal cord ischemia (SCI) or stroke, and any persistent neurologic deficit 30 days following the operation. During the study period, 62 patients underwent TEVAR and 56 underwent OTAR with median follow-up of 23.7 months and 36.4 months, respectively. No difference existed between the TEVAR and OTAR with respect to overall neurologic complications (8.1% vs. 12.5%, P = 0.55) as well as any residual neurologic deficit at 30 days (0% vs. 5.4%, P = 0.10). TEVAR patients had fewer complications including pneumonia (P = 0.02), rebleeding (P = 0.02), and acute kidney injury (P = 0.001). There was no difference in 30-day mortality (1.6% vs. 8.9%, P = 0.10), 1-year mortality (12.2% vs. 14%, P = 0.80), or 5-year mortality (53.9% vs. 44%, P = 0.48) between TEVAR and OTAR, respectively. Conclusions: TEVAR continues to show improved perioperative outcomes with a trend toward decreased 30-day mortality and fewer major adverse events compared with OTAR. However, with the routine use of end-organ preservation strategies during OTAR, neurologic deficits, particularly SCI, can be safely reduced to comparable levels with those of TEVAR and 1-year all-cause mortality rates are similar between the groups. These OTAR results may serve as a benchmark as TEVAR is increasingly applied for other aortic pathologies, such as chronic dissection, wherein long-term efficacy is not proven.

AB - Background: Pivotal trials showed that thoracic endovascular aortic repair (TEVAR) has improved outcomes compared with open surgery for treating descending thoracic aortic aneurysms. However, those trials included historical open controls in which modern end-organ preservation strategies were not routinely employed. To create a more level assessment, we compared our outcomes of elective TEVAR with modern open thoracic aortic repair (OTAR) controls. Methods: A retrospective review of thoracic aortic aneurysm patients undergoing TEVAR was compared with a contemporaneous cohort of OTAR patients. Partial bypass or hypothermic circulatory arrest was used in all OTAR patients. Cerebrospinal fluid drain placement was attempted in all patients. Preoperative characteristics, operative variables, and outcomes were recorded, and the Kaplan-Meier method was used for survival estimates. Results: The main outcome was mortality. Secondary outcomes included postoperative spinal cord ischemia (SCI) or stroke, and any persistent neurologic deficit 30 days following the operation. During the study period, 62 patients underwent TEVAR and 56 underwent OTAR with median follow-up of 23.7 months and 36.4 months, respectively. No difference existed between the TEVAR and OTAR with respect to overall neurologic complications (8.1% vs. 12.5%, P = 0.55) as well as any residual neurologic deficit at 30 days (0% vs. 5.4%, P = 0.10). TEVAR patients had fewer complications including pneumonia (P = 0.02), rebleeding (P = 0.02), and acute kidney injury (P = 0.001). There was no difference in 30-day mortality (1.6% vs. 8.9%, P = 0.10), 1-year mortality (12.2% vs. 14%, P = 0.80), or 5-year mortality (53.9% vs. 44%, P = 0.48) between TEVAR and OTAR, respectively. Conclusions: TEVAR continues to show improved perioperative outcomes with a trend toward decreased 30-day mortality and fewer major adverse events compared with OTAR. However, with the routine use of end-organ preservation strategies during OTAR, neurologic deficits, particularly SCI, can be safely reduced to comparable levels with those of TEVAR and 1-year all-cause mortality rates are similar between the groups. These OTAR results may serve as a benchmark as TEVAR is increasingly applied for other aortic pathologies, such as chronic dissection, wherein long-term efficacy is not proven.

UR - http://www.scopus.com/inward/record.url?scp=84931568293&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84931568293&partnerID=8YFLogxK

U2 - 10.1016/j.avsg.2015.01.007

DO - 10.1016/j.avsg.2015.01.007

M3 - Article

C2 - 25757992

AN - SCOPUS:84931568293

VL - 29

SP - 882

EP - 890

JO - Annals of Vascular Surgery

JF - Annals of Vascular Surgery

SN - 0890-5096

IS - 5

ER -