Risk factors for early and late mortality after thoracic endovascular aortic repair

Objective

The risk factors associated with death after thoracic endovascular aortic repair are poorly understood. The aim of this study is to analyze the risk factors associated with early and late mortality after thoracic endovascular aortic repair.

Methods

A total of 153 patients underwent 184 thoracic endovascular aortic repairs between 1998 and 2005. Prospectively collected data were entered into statistical software. Univariate and multivariate analyses were performed.

Results

The underlying pathologies included descending thoracic aortic aneurysm (n = 91), acute type B aortic dissection (n = 25), chronic type B aortic dissection (n = 42), aortic transection (n = 12), and penetrating aortic ulcer (n = 14). Thoracic endovascular aortic repair was technically successful in all but 3 patients. Another 3 patients required an open repair within the first month. Early and late mortality rates were 9.8% (n = 18) and 19% (n = 35) in a 16-month average period of follow-up, respectively. Type I procedural endoleak was the only significant predictor of early death in the multivariate model (P = .0036; odds ratio: 8.4; 95% confidence interval: 1.6–43.9). Multivariate Cox regression revealed chronic obstructive pulmonary disease (P = .024; odds ratio: 3.8; 95% confidence interval: 1.2–12.1), postoperative myocardial infarction (P = .0053; odds ratio: 9.7; 95% confidence interval: 2.0–48.4), and acute renal failure (P = .0006; odds ratio: 22.8; 95% confidence interval: 3.8–137.6) to be independent risk factors for late mortality.

Conclusion

Procedural type I endoleak is an independent risk factor of early mortality after thoracic endovascular aortic repair. Chronic obstructive pulmonary disease, postoperative myocardial infarction, and acute renal failure are predictors of late death in the multivariate analysis.

Abbreviations and Acronyms: CT, computed tomography, POD, postoperative day, TEVAR, thoracic endovascular aortic repair

CTSNet Classification: 18, 26, 28