Outcomes of Thoracic Endovascular Aortic Repair in Octogenarians

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 underg...

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Published in:	Vascular and endovascular surgery Vol. 56; no. 2; pp. 158 - 165
Main Authors:	Alnahhal, Khaled I., Narayanan, Meyyammai K, Lingutla, Ranjana, Parikh, Shailraj, Iafrati, Mark, Kumar, Shivani, Zhan, Yong, Salehi, Payam
Format:	Journal Article
Language:	English
Published:	Los Angeles, CA SAGE Publications 01-02-2022
Subjects:	Aged Aged, 80 and over Aortic Aneurysm, Thoracic - diagnostic imaging Aortic Aneurysm, Thoracic - surgery Blood Vessel Prosthesis Implantation - adverse effects Endovascular Procedures - adverse effects Female Humans Male Middle Aged Octogenarians Postoperative Complications - etiology Retrospective Studies Risk Factors Treatment Outcome thoracic endovascular aortic repair octogenarians thoracic aortic aneurysm outcomes
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Summary:	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.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1538-5744 1938-9116
DOI:	10.1177/15385744211051502