Endovascular Versus Open Repair of Intact Descending Thoracic Aortic Aneurysms

Peter Chiu, Andrew B. Goldstone, Justin M. Schaffer, Bharathi Lingala, D. Craig Miller, R. Scott Mitchell, Y. Joseph Woo, Michael P. Fischbein, Michael D. Dake

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: For the management of descending thoracic aortic aneurysms, recent evidence has suggested that outcomes of open surgical repair may surpass thoracic endovascular aortic repair (TEVAR) in as early as 2 years. Objectives: The purpose of this study was to evaluate the comparative effectiveness of TEVAR and open surgical repair in the treatment of intact descending thoracic aortic aneurysms. Methods: Using the Medicare database, a retrospective study using regression discontinuity design and propensity score matching was performed on patients with intact descending thoracic aortic aneurysms who underwent TEVAR or open surgical repair between 1999 and 2010 with follow-up through 2014. Survival was assessed with restricted mean survival time. Perioperative mortality was assessed with logistic regression. Reintervention was evaluated as a secondary outcome. Results: Matching created comparable groups with 1,235 open surgical repair patients matched to 2,470 TEVAR patients. The odds of perioperative mortality were greater for open surgical repair: high-volume center, odds ratio (OR): 1.97 (95% confidence interval [CI]: 1.53 to 2.61); low-volume center, OR: 3.62 (95% CI: 2.88 to 4.51). The restricted mean survival time difference favored TEVAR at 9 years, −209.2 days (95% CI: −298.7 to −119.7 days; p < 0.001) for open surgical repair. Risk of reintervention was lower for open surgical repair, hazard ratio: 0.40 (95% CI: 0.34 to 0.60; p < 0.001). Conclusions: Open surgical repair was associated with increased odds of early postoperative mortality but reduced late hazard of death. Despite the late advantage of open repair, mean survival was superior for TEVAR. TEVAR should be considered the first line for repair of intact descending thoracic aortic aneurysms in Medicare beneficiaries.

Original languageEnglish (US)
Pages (from-to)643-651
Number of pages9
JournalJournal of the American College of Cardiology
Volume73
Issue number6
DOIs
StatePublished - Feb 19 2019
Externally publishedYes

Fingerprint

Thoracic Aortic Aneurysm
Thorax
Confidence Intervals
Medicare
Mortality
Survival Rate
Odds Ratio
Propensity Score
Survival
Retrospective Studies
Logistic Models
Databases

Keywords

  • aortic surgery
  • descending aorta
  • endovascular surgery
  • TEVAR
  • thoracic aorta

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Endovascular Versus Open Repair of Intact Descending Thoracic Aortic Aneurysms. / Chiu, Peter; Goldstone, Andrew B.; Schaffer, Justin M.; Lingala, Bharathi; Miller, D. Craig; Mitchell, R. Scott; Woo, Y. Joseph; Fischbein, Michael P.; Dake, Michael D.

In: Journal of the American College of Cardiology, Vol. 73, No. 6, 19.02.2019, p. 643-651.

Research output: Contribution to journalArticle

Chiu, P, Goldstone, AB, Schaffer, JM, Lingala, B, Miller, DC, Mitchell, RS, Woo, YJ, Fischbein, MP & Dake, MD 2019, 'Endovascular Versus Open Repair of Intact Descending Thoracic Aortic Aneurysms', Journal of the American College of Cardiology, vol. 73, no. 6, pp. 643-651. https://doi.org/10.1016/j.jacc.2018.10.086
Chiu, Peter ; Goldstone, Andrew B. ; Schaffer, Justin M. ; Lingala, Bharathi ; Miller, D. Craig ; Mitchell, R. Scott ; Woo, Y. Joseph ; Fischbein, Michael P. ; Dake, Michael D. / Endovascular Versus Open Repair of Intact Descending Thoracic Aortic Aneurysms. In: Journal of the American College of Cardiology. 2019 ; Vol. 73, No. 6. pp. 643-651.
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abstract = "Background: For the management of descending thoracic aortic aneurysms, recent evidence has suggested that outcomes of open surgical repair may surpass thoracic endovascular aortic repair (TEVAR) in as early as 2 years. Objectives: The purpose of this study was to evaluate the comparative effectiveness of TEVAR and open surgical repair in the treatment of intact descending thoracic aortic aneurysms. Methods: Using the Medicare database, a retrospective study using regression discontinuity design and propensity score matching was performed on patients with intact descending thoracic aortic aneurysms who underwent TEVAR or open surgical repair between 1999 and 2010 with follow-up through 2014. Survival was assessed with restricted mean survival time. Perioperative mortality was assessed with logistic regression. Reintervention was evaluated as a secondary outcome. Results: Matching created comparable groups with 1,235 open surgical repair patients matched to 2,470 TEVAR patients. The odds of perioperative mortality were greater for open surgical repair: high-volume center, odds ratio (OR): 1.97 (95{\%} confidence interval [CI]: 1.53 to 2.61); low-volume center, OR: 3.62 (95{\%} CI: 2.88 to 4.51). The restricted mean survival time difference favored TEVAR at 9 years, −209.2 days (95{\%} CI: −298.7 to −119.7 days; p < 0.001) for open surgical repair. Risk of reintervention was lower for open surgical repair, hazard ratio: 0.40 (95{\%} CI: 0.34 to 0.60; p < 0.001). Conclusions: Open surgical repair was associated with increased odds of early postoperative mortality but reduced late hazard of death. Despite the late advantage of open repair, mean survival was superior for TEVAR. TEVAR should be considered the first line for repair of intact descending thoracic aortic aneurysms in Medicare beneficiaries.",
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T1 - Endovascular Versus Open Repair of Intact Descending Thoracic Aortic Aneurysms

AU - Chiu, Peter

AU - Goldstone, Andrew B.

AU - Schaffer, Justin M.

AU - Lingala, Bharathi

AU - Miller, D. Craig

AU - Mitchell, R. Scott

AU - Woo, Y. Joseph

AU - Fischbein, Michael P.

AU - Dake, Michael D.

PY - 2019/2/19

Y1 - 2019/2/19

N2 - Background: For the management of descending thoracic aortic aneurysms, recent evidence has suggested that outcomes of open surgical repair may surpass thoracic endovascular aortic repair (TEVAR) in as early as 2 years. Objectives: The purpose of this study was to evaluate the comparative effectiveness of TEVAR and open surgical repair in the treatment of intact descending thoracic aortic aneurysms. Methods: Using the Medicare database, a retrospective study using regression discontinuity design and propensity score matching was performed on patients with intact descending thoracic aortic aneurysms who underwent TEVAR or open surgical repair between 1999 and 2010 with follow-up through 2014. Survival was assessed with restricted mean survival time. Perioperative mortality was assessed with logistic regression. Reintervention was evaluated as a secondary outcome. Results: Matching created comparable groups with 1,235 open surgical repair patients matched to 2,470 TEVAR patients. The odds of perioperative mortality were greater for open surgical repair: high-volume center, odds ratio (OR): 1.97 (95% confidence interval [CI]: 1.53 to 2.61); low-volume center, OR: 3.62 (95% CI: 2.88 to 4.51). The restricted mean survival time difference favored TEVAR at 9 years, −209.2 days (95% CI: −298.7 to −119.7 days; p < 0.001) for open surgical repair. Risk of reintervention was lower for open surgical repair, hazard ratio: 0.40 (95% CI: 0.34 to 0.60; p < 0.001). Conclusions: Open surgical repair was associated with increased odds of early postoperative mortality but reduced late hazard of death. Despite the late advantage of open repair, mean survival was superior for TEVAR. TEVAR should be considered the first line for repair of intact descending thoracic aortic aneurysms in Medicare beneficiaries.

AB - Background: For the management of descending thoracic aortic aneurysms, recent evidence has suggested that outcomes of open surgical repair may surpass thoracic endovascular aortic repair (TEVAR) in as early as 2 years. Objectives: The purpose of this study was to evaluate the comparative effectiveness of TEVAR and open surgical repair in the treatment of intact descending thoracic aortic aneurysms. Methods: Using the Medicare database, a retrospective study using regression discontinuity design and propensity score matching was performed on patients with intact descending thoracic aortic aneurysms who underwent TEVAR or open surgical repair between 1999 and 2010 with follow-up through 2014. Survival was assessed with restricted mean survival time. Perioperative mortality was assessed with logistic regression. Reintervention was evaluated as a secondary outcome. Results: Matching created comparable groups with 1,235 open surgical repair patients matched to 2,470 TEVAR patients. The odds of perioperative mortality were greater for open surgical repair: high-volume center, odds ratio (OR): 1.97 (95% confidence interval [CI]: 1.53 to 2.61); low-volume center, OR: 3.62 (95% CI: 2.88 to 4.51). The restricted mean survival time difference favored TEVAR at 9 years, −209.2 days (95% CI: −298.7 to −119.7 days; p < 0.001) for open surgical repair. Risk of reintervention was lower for open surgical repair, hazard ratio: 0.40 (95% CI: 0.34 to 0.60; p < 0.001). Conclusions: Open surgical repair was associated with increased odds of early postoperative mortality but reduced late hazard of death. Despite the late advantage of open repair, mean survival was superior for TEVAR. TEVAR should be considered the first line for repair of intact descending thoracic aortic aneurysms in Medicare beneficiaries.

KW - aortic surgery

KW - descending aorta

KW - endovascular surgery

KW - TEVAR

KW - thoracic aorta

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