Investigation of risk factors and outcomes of aortic arch aneurysm repair in octogenarians

P0182 

Abstract Submission 

Tomoki Cho (1), Keiji Uchida (2), Shota Yasuda (3), Tomoyuki Minami (4), aya saito (3)

(1) Yokohama city university medical center, Yokohama, Kanagawa, (2) Yokohama City University Medical Center, Yokohama, Kanagawa, (3) N/A, N/A, (4) N/A, Yokohama, Japan

Tomoki Cho    -  Contact Me
Yokohama city university medical center

Keiji Uchida    -  Contact Me
Yokohama City University Medical Center

Shota Yasuda    -  Contact Me
N/A

Tomoyuki Minami    -  Contact Me
N/A

aya saito    -  Contact Me
N/A

Tomoki Cho    -  Contact Me
Yokohama city university medical center

[Objective] Total arch replacement is the first-choice treatment for aortic arch aneurysms; however, total arch replacement is a high-risk procedure, and endovascular repair may be the treatment of choice in elderly patients. We investigated the risk factors associated with each technique and treatment outcomes of aortic arch aneurysm repair in elderly patients (age >80 years).

[Methods] The study included 54 octogenarians who underwent aortic arch aneurysm repair between 2007 and 2021. Patients were categorized into the total arch replacement (TAR) group (23 patients) and the thoracic endovascular aortic repair (TEVAR) group (31 patients). Early and mid-term outcomes and risk factors associated with mortality were investigated in each group. TAR was the preferred therapy; however, TEVAR was performed in patients who were unable to tolerate TAR owing to frailty and comorbidities. True aneurysms were included and dissected aneurysms and emergency cases secondary to aneurysm rupture or other causes were excluded from the analysis to ensure evaluation of timely surgical outcomes.

[Results] Patients' mean age was 82 years in both groups (TAR [81-84 years], TEVAR [81-83 years]), without a significant intergroup difference. The incidence of stroke and spinal cord ischemia, the 30-day mortality (TAR [0.0%], TEVAR [5.4%]), and in-hospital mortality (TAR [7.7%], TEVAR [8.1%]) did not show significant intergroup differences. The 5-year survival rates (TAR [82.0%], TEVAR [65.0%], p=0.24), aorta-related mortality averted (TAR [91.0%], TEVAR [81.0%], p=0.13), and the freedom from aortic events (p=0.05) did not show significant intergroup differences. On analysis of risk factors for all-cause mortality for each procedure, a history of ischemic heart disease was identified as a significant risk factor in the TAR group. No significant risk factors were identified in the TEVAR group in this study.

[Conclusions] The choice of procedure in this study was reasonable considering patients' frailty. Endovascular repair is a good option for patients with a history of ischemic heart disease.

Aortic Arch