LAUSR

BACKGROUND Thoracic Endovascular Aortic Repair (TEVAR) is a suitable alternative to open aortic surgery especially for older patients with poor general health and functional status. However, data on the benefit of TEVAR in elderly patients are limited. The aim of this study is to use a large national database to compare the outcomes of TEVAR in octogenarians vs. non-octogenarians in the treatment of thoracic aortic aneurysms and dissection. METHODS All patients who underwent TEVAR for non-ruptured thoracic aneurysms or dissection (zones 1-5) between January 2014 and February 2019 were identified in the Vascular Quality Initiative (VQI) database. The primary outcome was in-hospital mortality. Secondary outcomes included cardiac adverse events, neurological events, respiratory complications, new-onset dialysis, leg compartment syndrome, postoperative hematoma in addition to spinal, bowel, arm and leg emboli/ischemia, and return to the operating room. Outcomes were compared between octogenarians (age ≥ 80 years) and non-octogenarians (age < 80 years) using univariable and multivariable logistic regression models. RESULTS A total of 2,042 patients were identified, including 390 octogenarians (19.1%). Compared to non-octogenarians, octogenarians had higher percentages of females (49.5% vs. 40.4%, p<.01) and white patients (75.9% vs. 68.6%, p<.01) and were more likely to present with thoracic aneurysms (86.2% vs. 64.3%, p<.001). They also had larger aortic diameters (maximum diameter ± SD: 60.3 ± 15.8 vs. 53.4 ± 17.4 mm), less proximal disease zones (zone 1: 3.3% vs. 5.5%, zone 2: 13.9% vs. 24.1%, p < .001) and were more likely to undergo the procedure under local/regional anesthesia (5.4% vs. 2.4%, p<0.01) compared to patients <80 years of age. No association was observed between octogenarians and in-hospital mortality after TEVAR for aneurysms (5.1% vs. 3.3%, OR,1.38; 95% CI, 0.72-2.61; P=.33) or dissection (5.6% vs. 4.9%, OR, 0.68; 95%CI,0.14-3.32; p=.63). However, for thoracic aneurysm repair, octogenarians had 44% higher adjusted odds of in-hospital complications (27.4% vs. 20.7%, OR: 1.44, 95%CI: 1.04-1.98, p=.03) compared to their younger counterparts. In-hospital complications (27.8% vs. 26.2%, p=0.79, OR: 1.02, 95%CI: 0.50-2.11, P=0.95) were similar in octogenarians undergoing endovascular repair for dissections of the thoracic aorta. Octogenarians were also associated with 1.74 times the mortality hazard compared to non-octogenarians (aHR: 1.74, 95%CI: 1.18-2.58, P=.01). CONCLUSIONS TEVAR is an acceptable treatment option for octogenarians who have aortic arch and descending aortic aneurysms or dissections (zones 1-5). However, in case of aneurysms, they might be at a higher risk of in-hospital complications. Octogenarians also had increased hazard of 1-year mortality; however, the exact cause of this mortality could not be deciphered. Our findings suggest that elderly patients should not be denied TEVAR based on age if they were medically and anatomically fit for this procedure.