Outcomes of Thoracic Endovascular Aortic Repair in Octogenarians

Abstract

Objective The aim of this study is to compare outcomes between octogenarians and non-octogenarians undergoing thoracic endovascular aortic repair (TEVAR). Methods Using the National Inpatient Sample database, we identified octogenarians (≥80 years) and non-octogenarians (<80 years) who had undergone thoracic endovascular aortic repair between 2012 and 2017. We compared patients’ demographic, socioeconomic, comorbidity data between the two groups as well as the procedure indications and perioperative outcomes. A multivariable logistic regression analysis was conducted to evaluate the impact of advanced age (≥80 years) on the in-hospital mortality rates in patients who underwent TEVAR. This analysis was also performed for a separate cohort which included only patients who underwent TEVAR for ruptured thoracic aortic aneurysm. Results A total of 4108 patients were included in our study; 3432 (83.5%) patients were <80 years (37.9% female; median age, 64 years; 34.3% non-white) and 676 (16.5%) patients were ≥80 years (50.7% female; median age, 83 years; 20.4% non-white). Non-ruptured thoracic aortic aneurysm was the most common indication for TEVAR in older patients (61.4%), whereas type B aortic dissection was the most common indication in younger patients (36.4%). In-hospital complications were comparable between the two groups except for respiratory complications that were higher in the younger patients (21.2% vs. 15.2%; P <.001). The multivariable analysis demonstrated that advanced age had no association with increased in-hospital mortality rates (adjusted odds ratio [aOR], 1.41; 95% confidence interval [CI], .97-2.05), However, in ruptured thoracic aortic aneurysm cohort, octogenarians had higher in-hospital mortality rates (aOR, 1.86; 95% CI, 1.04-3.32). Conclusions Octogenarians have acceptable rates of perioperative morbidity and mortality compared to the younger group and should be considered for TEVAR. Octogenarians are at higher risk for in-hospital mortality in the setting of ruptured thoracic aortic aneurysm, supporting the appropriateness of elective TEVAR in selected Octogenarians.

Long-Term Outcomes of Endovascular Repair of Thoracic Aortic Aneurysms

“…A separate review of the National Inpatient Sample database from 2012 to 2017 identified 676 (16.5%) patients over the age of 80 from a total of 4,108 patients who underwent TEVAR during the study period. 69 These patients also trended slightly more female and were majority white. DTAA was the pathology in 61.4% of octogenarians.…”

Comparative Analysis of Morbidity and Mortality Outcomes in Elderly and Nonelderly Patients Undergoing Elective TEVAR: A Systematic Review and Meta-Analysis

“…The elderly patients were defined as the experimental group and nonelderly patients as the control group. From the included studies, eight studies used 80 years of age for defining elderly [4,[9][10][11][12][13][14][15], three studies used 75 years of age [1,16,17], and one subgrouped patients in >75 and >80 age groups [5]. Studies that used cutoff points below the age of 75 were excluded from the analysis.…”

“…Seven studies directly compared TEVAR outcomes between elderly and nonelderly patients [1,4,5,10,12,14,17], with three studies comparing emergency and elective TEVAR procedures [5,9,11]. In addition, six studies conducted KM analysis investigating the overall survival (OS) in elderly patients undergoing TEVAR [1,4,5,13,15,16]. A minimum of three studies per outcome were needed for data synthesis and analysis.…”

“…(a) Comparison of respiratory complications between elderly vs. nonelderly patients undergoing TEVAR. (b) Funnel plot assessing the publication bias for respiratory complications.References:[6,12,16,18].…”

“…E: elderly, NE: nonelderly, TAA: thoracic aortic aneurysm, AD: aortic dissection, Other: penetrating aortic ulcer (PAU), traumatic aortic injury (TAI), intramural haematoma (IMH). References:[1,4,5,[9][10][11][12][13][14][15][16][17].…”