HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Himanshu J. Patel Richard L. Prager G. Michael Deeb Permission Requests Google Scholar Articles by Patel, H. J. Articles by Deeb, G. M. PubMed Articles by Patel, H. J. Articles by Deeb, G. M. Related Collections Great vessels

---

Original Articles: Adult Cardiac

A Comparison of Open and Endovascular Descending Thoracic Aortic Repair in Patients Older Than 75 Years of Age

^a Department of Surgery, University of Michigan Hospitals, Ann Arbor, Michigan
^b Department of Radiology, University of Michigan Hospitals, Ann Arbor, Michigan
^c Section of Interventional Radiology, University of Michigan Hospitals, Ann Arbor, Michigan

Accepted for publication January 11, 2008.

^_* Address correspondence to Dr Patel, Section of Cardiac Surgery, CVC Room 5144, 1500 E Medical Center Dr, SPC 5864, Ann Arbor, MI 48109-5864 (Email: hjpatel{at}med.umich.edu).

Presented at the Fifty-fourth Annual Meeting of the Southern Thoracic Surgical Association, Bonita Springs, FL, Nov 7-10, 2007.

Background: Thoracic aortic endovascular repair (TEVAR) holds great promise in the elderly population. We conducted a concurrent comparison of TEVAR with open descending thoracic aneurysm repair (DTAR) in elderly patients to determine the more appropriate therapeutic option.

Methods: Since 1993, 93 patients aged 75 years and older have undergone open (n = 41) or endovascular (n = 52) descending aortic repair. Intervention indications included aneurysms, dissection, or traumatic injury. Mean maximum aortic diameter was 6.1 cm. Contained rupture was more frequent in TEVAR (p = 0.005); 52 needed arch repair, and 46 needed total descending repair.

Results: The mean age was 78.9 years (TEVAR, 80.6 vs DTAR, 76.9; p < 0.0001). The TEVAR patients had more significant comorbidities; 42 (80.8%) were prospectively identified as nonoperative candidates. Thirty-day mortality was higher in DTAR at 7 (17.1%) vs TEVAR at 3 (5.7%, p = 0.1). The composite end point of 30-day death, stroke, permanent paralysis, or dialysis requirement was similar (TEVAR, 9; DTAR, 10; p = 0.45). Median postoperative length of stay was shorter in TEVAR (6 days) vs DTAR (13 days; p = 0.003). Endoleaks were observed in 12. Actuarial survival at 48 months was similar (mean survival: TEVAR, 30.2 months vs DTAR, 33.7 months; p = 0.49).

Conclusions: Despite more complex preoperative comorbidities, the TEVAR group had shorter hospitalization, a trend towards a reduction in early mortality, and similar late outcomes. This comparative analysis suggests that thoracic endovascular repair may be a more suitable therapeutic option in this complex elderly group.