Thoracic Endovascular Aortic Repair Outcomes in Octogenarians and Nonagenarians, a Single Center Experience

P0347 

Abstract Submission 

Halim Yammine (1), Raza Ahmad (1), John Frederick (1), Gregory Stanley (1), Charles Briggs (1), Garrett Clemons (1), Hector Crespo Soto (1), Tzvi Nussbaum (1), Jeko Madjarov (1), Frank Arko (1)

(1) Sanger Heart and Vascular Institute, Charlotte, NC

Halim Yammine    -  Contact Me
Sanger Heart and Vascular Institute

Raza Ahmad    -  Contact Me
Sanger Heart and Vascular Institute

John Frederick    -  Contact Me
Sanger Heart and Vascular Institute

Gregory Stanley    -  Contact Me
Sanger Heart and Vascular Institute

Charles Briggs    -  Contact Me
Sanger Heart and Vascular Institute

Garrett Clemons    -  Contact Me
Sanger Heart and Vascular Institute

Hector Crespo Soto    -  Contact Me
Sanger Heart and Vascular Institute

Tzvi Nussbaum    -  Contact Me
Sanger Heart and Vascular Institute

Jeko Madjarov    -  Contact Me
Sanger Heart and Vascular Institute

Frank Arko    -  Contact Me
Sanger Heart and Vascular Institute

Halim Yammine    -  Contact Me
N/A

Thoracic Endovascular Aortic Repair Outcomes in Octogenarians and Nonagenarians, a Single Center Experience
Raza Ahmad, MD1, Halim Yammine, MD1, John R. Frederick, MD1, Gregory Stanley, MD1, Charles S. Briggs, MD1, Garrett Clemons, PhD1, Hector Crespo-Soto, MD1, Tzvi Nussbaum, MD1, Jeko Madjarov, MD1, Frank R. Arko, III, MD1
1Atrium Health Sanger Heart and Vascular Institute, Charlotte, NC

Objective
The primary goal of this study is to evaluate outcomes of elderly patients who underwent Thoracic Endovascular Aortic Repair (TEVAR).

Methods
Retrospective study from a prospectively maintained single-center database. We identified 506 patients who underwent TEVAR. 50 patients were ≥ 80 years of age. Their data were analyzed to assess primary outcomes (survival and reintervention). Trends in patient demographics, aortic history, TEVAR indication, preoperative status, intraoperative details, and postoperative outcomes were evaluated as well.



Results
Average patient age was 83.6 years, and 60% were females in contrast to only 42.3% in patients younger than 80 (p=0.02). Most of the patients were white (86%) with the next highest reported ethnicity being Black (5%). 19/50 (38%) had coronary artery disease (CAD) compared to only 21% in the younger group (p=0.01). COPD and Hyperlipidemia were also more prevalent in patients older than 80 (p=0.05 for both). The most frequent indication for TEVAR was type B aortic dissection (TBAD) (28/50, 56%), followed by intact thoracic or thoracoabdominal aneurysm (21/50, 42%) with an average aortic diameter of 7.15 cm. A lone case of tumor erosion into the thoracic aorta represents the remainder of TEVAR indication (1/50, 2%).
Landing zones proximal to the left subclavian artery were in 24/50 (48%) (Zone 0 2/50, Zone 1 4/50, Zone 2 18/50) and 7 great vessel debranching procedures were performed. The 30-day stroke rate was 4% (2/50), and there were no instances of myocardial infarction (MI), bowel ischemia, extremity ischemia or spinal cord ischemia at 30- days. Retrograde Type A dissection (RTAD) was observed in 6% (3/50) of patients with one patient undergoing repair. The overall re-intervention rate was 16%. Aortic-related mortality was 10% (5/50). Kaplan Meier estimates for overall survival at 30 days, 1 year, 2 years, 3 years, 4 years, and 5 years were 84%, 67.4%, 55.1%, 47.7%, 40.9%, and 30.7% respectively.

Conclusions
TEVAR can be performed safely and efficiently in patients older than 80 years of age. Even though patients should not be denied a potentially lifesaving procedure based on age alone, careful consideration of all comorbidities is important to ensure the best outcomes. Also, a clear and honest conversation with the patients and their families is crucial to set expectations given the high overall mortality over time.

Descending/Thoracoabdominal Aorta