Outcomes of Open Versus Endovascular Repair of Descending Thoracic and Thoracoabdominal Aortic Aneurysms

医学 外科 支架 倾向得分匹配 透析 主动脉修补术 主动脉瘤 冲程(发动机) 动脉瘤 腔内修复术 动脉瘤 心胸外科 腹主动脉瘤 机械工程 工程类
作者
Michael Z. Tong,Matthew J. Eagleton,Eric E. Roselli,Eugene H. Blackstone,Xiang Fei,Mudathir Ibrahim,Douglas R. Johnston,Edward G. Soltesz,Faisal G. Bakaeen,Sean P. Lyden,Andrew J. Toth,Huan Liu,Lars G. Svensson
出处
期刊:The Annals of Thoracic Surgery [Elsevier]
卷期号:113 (4): 1144-1152 被引量:23
标识
DOI:10.1016/j.athoracsur.2021.04.100
摘要

Open repair is the standard of care for patients with descending thoracic and thoracoabdominal aortic aneurysms. Although effective, surgery carries a high risk of morbidity and mortality. Endovascular stent grafts were introduced to treat these aneurysms in patients considered too high risk for open repair. Early results are promising, but later results are incompletely known. Therefore, we sought to compare short- and intermediate-term outcomes of open vs endovascular repair for these aneurysms.From 2000 to 2010, 1053 patients underwent open (n = 457) or endovascular (n = 596) repair of descending thoracic and thoracoabdominal aortic aneurysms at Cleveland Clinic. To balance patient characteristics between these groups, propensity score matching was performed, yielding 278 well-matched pairs (61% of possible pairs). End points included short- and long-term outcomes.In matched patients, compared with endovascular stenting, open repair achieved similar in-hospital death (n = 23 [8.3%] vs n = 21 [7.6%], P = .80) and occurrence of paralysis and stroke (n = 10 [3.6%] vs n = 6 [2.2%], P = .30), despite a longer postoperative stay (median 11 vs 6 days), more dialysis-dependent acute renal failure (n = 24 [8.6%] vs n = 9 [3.3%], P = .008), and prolonged ventilation (n = 106 [46%] vs n = 17 [6.3%], P < .0001). Open repair resulted in better 10-year survival than endovascular repair (52% vs 33%, P < .0001), and aortic reintervention was less frequent (4% vs 21%, P < .0001). Despite a decrease in the first postoperative year, average aneurysm size did not recover to normal range after endovascular stenting.Open repair of descending thoracic and thoracoabdominal aneurysms can achieve acceptable short-term outcomes with better intermediate-term outcomes than endovascular repair.

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