Longitudinal outcomes of thoracic endovascular aortic repair for ruptured thoracic aortic aneurysms

• Published in: The Journal of thoracic and cardiovascular surgery
• Main Authors: Fiandeiro, Miguel, Goel, Nicholas J., Mosbahi, Selim, Berezowski, Mikolaj, Lutfi, Waseem, Peev, Andrew, Jiang, Fei, Fairman, Alexander S., Desai, Nimesh D.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 15-07-2024
• Subjects: emergent repair; ruptured thoracic aortic aneurysm; thoracic endovascular aortic repair; thoracic endovascular aortic repair; CI; TEVAR; rTAA; emergent repair; ICU; iTAA; rTAAh; ruptured thoracic aortic aneurysm; rTAAu; Thoracic endovascular aortic repair
• ISSN: 0022-5223; 1097-685X; 1097-685X
• DOI: 10.1016/j.jtcvs.2024.07.020

Limited data exist on long-term mortality and reintervention rates after emergent thoracic endovascular aortic repair (TEVAR) for ruptured thoracic aortic aneurysm (rTAA). This study aimed to characterize the long-term outcomes of emergent TEVAR for rTAA.
All TEVARs for rTAA and elective intact thoracic aortic aneurysms (iTAAs) were reviewed at a large academic medical center from 2005 to 2022. Long-term clinical outcomes were considered over eight years.
Of 321 patients undergoing TEVAR for TAA, 20% (65/321) presented with rTAA. Median clinical follow-up was 5.1 years. rTAA patients had much lower 30-day survival (69.2% vs 96.9%; P < .001) and higher rates of stroke, pneumonia, and prolonged ventilation (all P ≤ .01). Long-term survival was worse for all rTAA patients compared to all iTAA patients at 1 year (46% vs 86%), 5 years (27% vs 48%), and 8 years (20% vs 32%; all P < .001), driven largely by frequent early mortality. However, for patients surviving at least 90 days, the long-term survival difference over 8 years was minimal (34% vs 33%, log-rank P = .43) among patients presenting with ruptured vs intact TAA. Ruptured aneurysms required more reinterventions within 30 days, but had comparable late reintervention rates, with type I endoleak as the leading cause.
The present study is the largest to focus on long-term outcomes following TEVAR for rupture TAA. Unsuprisingly, short-term outcomes are worse in patients presenting with ruptured vs intact aneurysms. However, importantly, long-term survival in rTAA patients who do survive 90 days is comparable to that of iTAA patients.
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