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Outcomes after endovascular versus open thoracoabdominal aortic aneurysm repair: A population-based study.

Authors
  • Rocha, Rodolfo V1
  • Lindsay, Thomas F2
  • Austin, Peter C3
  • Al-Omran, Mohammed4
  • Forbes, Thomas L2
  • Lee, Douglas S5
  • Ouzounian, Maral6
  • 1 Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada. , (Canada)
  • 2 Division of Vascular Surgery, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada. , (Canada)
  • 3 Cardiovascular Program, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. , (Canada)
  • 4 Division of Vascular Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. , (Canada)
  • 5 Cardiovascular Program, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada. , (Canada)
  • 6 Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada. Electronic address: [email protected] , (Canada)
Type
Published Article
Journal
The Journal of thoracic and cardiovascular surgery
Publication Date
Feb 01, 2021
Volume
161
Issue
2
Identifiers
DOI: 10.1016/j.jtcvs.2019.09.148
PMID: 31780062
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

We sought to determine the early and late outcomes of endovascular versus open thoracoabdominal aortic aneurysm repair. We performed a multicenter population-based study across the province of Ontario, Canada, from 2006 to 2017. The primary end point was mortality. Secondary end points were time to first event of a composite of mortality, permanent spinal cord injury, permanent dialysis, and stroke, the individual end points of the composite, patient disposition at discharge, hospital length of stay, myocardial infarction, and secondary procedures at follow-up. A total of 664 adults undergoing surgical repair of a thoracoabdominal aortic aneurysm (endovascular: n = 303 [45.5%] vs open: n = 361 [54.5%]) were identified using an algorithm of administrative codes validated against the operative records. Propensity score matching resulted in 241 patient pairs. Endovascular repairs increased during the study and currently comprise more than 50% of total repairs. In the matched sample, open repair was associated with a higher incidence of in-hospital death (17.4% vs 10.8%, P = .04), complications (26.1% vs 17.4%, P = .02), discharge to rehabilitation facilities (18.7% vs 10.0%, P = .02), and longer length of stay (12 [7-21] vs 6 [3-13] days, P < .01). Long-term mortality was not significantly different (hazard ratio, 1.09; 95% confidence interval, 0.78-1.50), nor were the other secondary end points, with the exception of secondary procedures, which were higher in the endovascular group (hazard ratio, 2.64; 95% confidence interval, 1.54-4.55). At 8 years, overall survival was 41.3% versus 44.6% after endovascular and open repair (P = .62). Endovascular repair was associated with improved early outcomes but higher rates of secondary procedures after discharge. Long-term survival after thoracoabdominal aortic aneurysm repair is poor and independent of repair technique. Copyright © 2019 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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