Comparison of Outcomes in Elective Endovascular Aortic Repair vs Open Surgical Repair of Abdominal Aortic Aneurysms

Autor: Elisa Greco, Deepak L. Bhatt, Mohamad A. Hussain, Mohammed Al-Omran, Muhammad Mamdani, Konrad Salata, Badr Aljabri, Thomas L. Forbes, Subodh Verma, Charles de Mestral
Jazyk: angličtina
Rok vydání: 2019
Předmět:
Zdroj: JAMA Network Open
ISSN: 2574-3805
Popis: This population-based cohort study compares long-term outcomes of elective endovascular aortic repair vs open surgical repair of abdominal aortic aneurysm among patients 40 years and older in Ontario, Canada.
Key Points Question What are the long-term outcomes of elective endovascular aortic repair of abdominal aortic aneurysms compared with those of open surgical repair? Findings In this population-based cohort study including 17 683 patients receiving elective treatment for abdominal aortic aneurysms, no statistically significant difference was found in long-term all-cause mortality between endovascular aortic repair and open surgical repair during a maximum follow-up of 13.8 years. Meaning Endovascular aortic repair was not associated with a long-term survival benefit.
Importance Knowledge regarding the long-term outcomes of elective treatment of abdominal aortic aneurysm (AAA) using endovascular aortic repair (EVAR) is increasing. However, data with greater than 10 years’ follow-up remain sparse and are lacking from population-based studies. Objective To determine the long-term outcomes of EVAR compared with open surgical repair (OSR) for elective treatment of AAA. Design, Setting, and Participants This retrospective, population-based cohort study used linked administrative health data from Ontario, Canada, to identify all patients 40 years and older who underwent elective EVAR or OSR for AAA repair from April 1, 2003, to March 31, 2016, with follow-up terminating on March 31, 2017. A total of 17 683 patients were identified using validated procedure and billing codes and were propensity score matched. Analysis was conducted from June 26, 2018, to January 16, 2019. Exposures Elective EVAR or OSR for AAA. Main Outcomes and Measures The primary outcome was overall survival. Secondary outcomes were major adverse cardiovascular event–free survival, defined as being free of death, myocardial infarction, or stroke; reintervention; and secondary rupture. Results Among 17 683 patients who received elective AAA repairs (mean [SD] age, 72.6 [7.8] years; 14 286 [80.8%] men), 6100 (34.5%) underwent EVAR and 11 583 (65.5%) underwent OSR. From these patients, 4010 well-balanced propensity score–matched pairs of patients were defined, with a mean (SD) age of 73.0 (7.6) years and 6583 (82.1%) men. In the matched cohort, the mean (SD) follow-up was 4.4 (2.7) years, and maximum follow-up was 13.8 years. The overall median survival was 8.9 years. Compared with OSR, EVAR was associated with a higher survival rate up to 1 year after repair (91.0% [95% CI, 90.1%-91.9%] vs 94.0% [95% CI, 93.3%-94.7%]) and a higher major adverse cardiovascular event–free survival rate up to 4 years after repair (69.9% [95% CI, 68.3%-71.3%] vs 72.9% [95% CI, 71.4%-74.4%]). Cumulative incidence of reintervention was higher among patients who underwent EVAR compared with those who underwent OSR at the 7-year follow-up (45.9% [95% CI, 44.1%-47.8%] vs 42.2% [95% CI, 40.4%-44.0%]). Survival analyses demonstrated no statistically significant differences in long-term survival, reintervention, and secondary rupture for patients who underwent EVAR compared with those who underwent OSR. Kaplan-Meier analysis suggested superior long-term major adverse cardiovascular event–free survival among patients who underwent EVAR compared with those who underwent OSR (32.6% [95% CI, 26.9%-38.4%] vs 14.1% [95% CI, 4.0%-30.4%]; stratified log-rank P
Databáze: OpenAIRE