Differences in Mid-Term Outcomes Between Patients Undergoing Thoracic Endovascular Aortic Repair for Aneurysm or Acute Aortic Syndromes: Report From the Global Registry for Endovascular Aortic Treatment

Daniele Bissacco; Maurizio Domanin; Fred A Weaver; Ali Azizzadeh; Charles C Miller; Dennis R Gable; Gabriele Piffaretti; Chiara Lomazzi; Santi Trimarchi

doi:10.1177/15266028211064819

Differences in Mid-Term Outcomes Between Patients Undergoing Thoracic Endovascular Aortic Repair for Aneurysm or Acute Aortic Syndromes: Report From the Global Registry for Endovascular Aortic Treatment

J Endovasc Ther. 2022 Oct;29(5):731-738. doi: 10.1177/15266028211064819. Epub 2021 Dec 15.

Authors

Daniele Bissacco¹, Maurizio Domanin^{1

2}, Fred A Weaver³, Ali Azizzadeh⁴, Charles C Miller⁵, Dennis R Gable⁶, Gabriele Piffaretti^{7

8}, Chiara Lomazzi¹, Santi Trimarchi^{1

2}

Affiliations

¹ Vascular Surgery Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
² Department of Clinical and Community Sciences, University of Milan, Milan, Italy.
³ Division of Vascular Surgery and Endovascular Therapy, University of Southern California, Los Angeles, CA, USA.
⁴ Division of Vascular Surgery, Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA, USA.
⁵ McGovern Medical School, Department of Cardiothoracic & Vascular Surgery, University of Texas Health Science Center, Houston, TX, USA.
⁶ Division of Vascular and Endovascular Surgery, Baylor Scott & White Heart Hospital, Plano, TX, USA.
⁷ Vascular Surgery Unit, ASST Sette Laghi, Varese, Italy.
⁸ Department of Medicine and Surgery, University of Insubria, Varese, Italy.

PMID: 34911391
DOI: 10.1177/15266028211064819

Abstract

Purpose: To analyze differences in baseline characteristics, overall mortality, device-related mortality, and re-intervention rates in patients who underwent thoracic endovascular aortic repair (TEVAR) for descending thoracic aortic aneurysm (DTAA) with atherosclerotic/degenerative cause or acute aortic syndrome (AAS), using the Global Registry For Endovascular Aortic Treatment (GREAT).

Materials and methods: Patients submitted to TEVAR for AAS or DTAA, included in GREAT, were eligible for this analysis. Primary outcome was 30-day all-cause mortality rate. Secondary outcomes were 30-day aorta-related mortality and re-intervention rate, 1-year and 3-year all-cause mortality, aorta-related mortality and re-intervention rate.

Results: Five-hundred and seventy-five patients were analyzed (305 DTAA and 270 AAS). Thirty-day mortality rate was 1.3% and 1.8% for DTAA and AAS, respectively (p=0.741). One-year and 3-year mortality rates were 6.2% versus 9.3 and 17.3% versus 15.9% for DTAA and AAS, respectively (p=0.209 and p=0.655, respectively). Aorta-related mortality rates at 30 days, 1 year and 3 years were 1.3%, 1.3%, and 2.6% for DTAA, 1.8%, 4.2%, and 4.2% for AAS (p=ns). Re-intervention rates at 30 days, 1 year, and 3 years were 1.3%, 4.3%, and 7.5% for DTAA, 3.3%, 8.1%, and 10.7% for AAS (p=ns). Furthermore, a specific analysis with similar outcomes was performed dividing follow-up in 3 periods (1-30 days, 31-365 days, 366-1096 days) and describing mutual differences between 2 groups and temporal trends in each group.

Conclusion: Patients who underwent TEVAR for DTAA or AAS experienced different mortality and re-intervention rates among years during mid-term follow-up. Although all-cause related deaths within 30 days were TEVAR-related, aorta-related deaths were more common for AAS patients within 1 year. A greater re-intervention rate was described for AAS patients, although only 1 year after TEVAR.

Keywords: GREAT registry; TEVAR; acute aortic syndrome; descending thoracic aortic aneurysm; endovascular aortic repair.

MeSH terms

Aneurysm* / etiology
Aortic Aneurysm, Thoracic* / diagnostic imaging
Aortic Aneurysm, Thoracic* / etiology
Aortic Aneurysm, Thoracic* / surgery
Blood Vessel Prosthesis Implantation* / adverse effects
Endovascular Procedures* / adverse effects
Humans
Registries
Retrospective Studies
Risk Factors
Syndrome
Time Factors
Treatment Outcome