P347. Thoracic Endovascular Aortic Repair Outcomes in Octogenarians and Nonagenarians, a Single Center Experience
Sanger Heart and Vascular Institute
NC
United States - Contact Me
My initial exposure to research was during my medical training at the American University of Beirut. I developed a passion for clinical and scientific investigation, which led me to two years of post-doctoral research via a fellowship at the Massachusetts General Hospital, Harvard Medical School. I learned the fundamentals of developing strong and rigorous research projects, as well as designing properly controlled experiments under the mentorship of Dr. Richard Hodin, MD. I had the opportunity to present our findings at the American College of Surgeons meeting as well as publish our findings in the Annals of Surgery. During my vascular surgery training at the Atrium Health Sanger Heart and Vascular Institute (SHVI) from 2016-2018, I helped establish an endovascular database which resulted in multiple ongoing research projects, presentations, and publications. Following the completion of my training, I was offered a surgical position at the SHVI as well as a clinical faculty appointment at Wake Forest University. I became the Director of Research for the Division of Vascular Surgery at SHVI, allowing me to continue to pursue the projects that I began as a fellow. I am dedicated to clinical research, through which my goal is to optimize current surgical and case management modalities to improve patient outcomes. Additionally, I am a strong proponent of investing in the creation and maintenance of institutional databases; analysis of these datasets offers clinicians meaningful feedback that can influence real-time treatment and decision-making to enhance patient outcomes. My experience in working with diverse patient populations has helped me to ensure an inclusive and respectful work environment for myself and others and propelled my desire to develop this equity in patient outcomes as well. I plan on continuing this aspect of my career to become an instrument of change and I am dedicated to a lifetime of improving and advancing vascular surgery and patient care.
Description
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.
Authors
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)
Institutions
(1) Sanger Heart and Vascular Institute, Charlotte, NC