Long-Term Outcomes and Risk Factors Analysis for Patients Undergoing Thoracic Endovascular Aorta Repair (TEVAR), According to the Aortic Pathologies.

Autor:	Gallo M; Cardiac Surgery, Cardiocentro Ticino Institute, EOC, Lugano, Switzerland., van den Berg JC; Centro Vascolare Ticino, Ospedale Regionale di Lugano, EOC, Lugano, Switzerland; Universitätsinstitut für Diagnostische, Interventionelle und Pädiatrische Radiologie, Inselspital, Universitätsspital Bern, Bern, Switzerland., Torre T; Cardiac Surgery, Cardiocentro Ticino Institute, EOC, Lugano, Switzerland., Riggi M; Cardiac Surgery, Cardiocentro Ticino Institute, EOC, Lugano, Switzerland; Department of Cardiovascular Surgery, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, Bern, Switzerland., Demertzis S; Cardiac Surgery, Cardiocentro Ticino Institute, EOC, Lugano, Switzerland; University of Italian Switzerland (USI), Biomedical Faculty, Lugano, Switzerland., Ferrari E; Cardiac Surgery, Cardiocentro Ticino Institute, EOC, Lugano, Switzerland; University of Italian Switzerland (USI), Biomedical Faculty, Lugano, Switzerland. Electronic address: enrico.ferrari@eoc.ch.
Jazyk:	angličtina
Zdroj:	Annals of vascular surgery [Ann Vasc Surg] 2023 Aug; Vol. 94, pp. 362-368. Date of Electronic Publication: 2023 Mar 11.
DOI:	10.1016/j.avsg.2023.02.012
Abstrakt:	Background: Thoracic endovascular aortic repair (TEVAR) has become a standard treatment for acute and chronic thoracic aorta diseases. We analyzed long-term outcomes and risk factors of TEVAR procedures according to the aortic pathology. Methods: Demographics, indications, technical details, and outcomes of patients undergoing TEVAR procedures in our institutions were prospectively collected and retrospectively analyzed. Overall survival was determined using Kaplan-Meier methods while log-rank tests were used to compare the survival between groups. Cox regression analysis was used to identify risk factors. Results: Between June 2002 and April 2020, 116 patients underwent TEVAR for different thoracic aorta diseases. Among them, 47 patients (41%) underwent TEVAR for aneurysmatic aortic disease, 26 (22%) for type-B aortic dissection, 23 (20%) for penetrating aortic ulcer, 11 (9%) after previous type-A dissection treatment, and 9 (8%) for traumatic aortic injury. Patients with posttraumatic aortic injury were younger (P < 0.01) with less hypertension (P < 0.01), diabetes (P < 0.01), and prior cardiac surgery (P < 0.01). Survival was different based on indication for TEVAR (log rank 0.024). Patients after previous type-A dissection treatment had the worst survival rate (50% at 5 years) while survival for aneurysmatic aortic disease was 55% at 5 years. No late death occurred in the traumatic group. Cox-regression model identified independent predictors for mortality: age (hazard ratio [HR]: 1.05, 95% confidence interval [CI]: 1.01-1.09, P = 0.006), male gender (HR: 3.2, 95% CI: 1.1-9.2, P = 0.028), moderate chronic obstructive pulmonary disease (HR: 2.1, 95% CI: 1.02-4.55, P = 0.043), previous cardiac surgery (HR: 2.1, 95% CI: 1.008-4.5, P = 0.048), and treatment indication for aneurysm (HR: 2.6, 95% CI: 1.2-5.2, P = 0.008). Conclusions: TEVAR is a safe and effective procedure with excellent long-term results in case of traumatic aortic injury. The overall long-term survival is affected by aortic pathology, associated comorbidities, gender, and previous cardiac surgery. (Copyright © 2023 Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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