Mid-term outcomes of Mycotic Arch/Descending Thoracic Aortic Aneurysm: TEVAR vs Open Repair

A. Arora¹, R. Ahmad², K. Monaghan³, B. Yang^4
1University of Michigan, Michigan Medicine, Ann Arbor, Michigan ²Michigan State University, College of Human Medicine, Grand Rapids, Michigan ³Michigan Medicine, Ann Arbor, Michigan ⁴University of Michigan / Michigan Medicine, Ann Arbor, Michigan

Purpose: To compare the mid-term survival impacts of open repair and TEVAR on mycotic arch and descending aortic aneurysms (MAA) and determine the optimal management of mycotic aneurysms.

Methods: Approximately 5300 TEVAR and open repair of aortic aneurysm patients were identified using the local STS database. Of these patients, 44 were determined to be mycotic aneurysms of the arch or descending aorta and verified by electronic medical record chart review. 14 of these patients underwent TEVAR and 30 underwent open repair. Preoperative demographics and postoperative outcomes were subsequently compared using chi-squared for categorical data and Wilcoxon rank-sum comparison of medians for continuous variables. Fisher exact analysis was done for categorical data with counts less than 5. Our primary outcome was mid-term survival. Data was presented n(%) for categorical data, and [median (25th percentile, 75th percentile)] for continuous data.

Results: There was no statistically significant difference in age, gender, or other preoperative demographics between TEVAR and Open repair of MAA, except for the incidence of COPD, which was higher in the TEVAR cohort (16% vs 11%, p=0.02). There was an expected significantly increased use of blood products in open repair in comparison to TEVAR of MAA (32% vs 5%, p=0.03). There was no significant difference in postoperative complications between the open repair and TEVAR groups. There was not a significant difference in length of stay between the TEVAR and open repair groups of MAA (16 days vs 14 days, p=0.75), readmission (9% vs 5%, p=0.63), or operative mortality (16% vs 5%, p=0.49) between the groups. The completeness of follow-up of survival was 98%. The 6-year survival was significantly better in the open repair group compared to the TEVAR group: 51% (95% confidence interval: 35%, 75%) vs 17% (95% CI: 5%, 58%), (p=0.014). The multivariable cox-proportional hazard ratio model showed the hazard ratio of the TEVAR group for midterm mortality was 1.90 (95% CI: 0.86-4.24, p=0.12), and the hazard ratio of COPD was 1.34 (95% CI: 0.55-3.26, p=0.52).

Conclusion: In comparison to TEVAR, open repair of MAA patients had no significant short-term difference in complications or survivability but did show improved mid-term survival. Open repair should be the first choice for MAA patients.

Identify the source of the funding for this research project: NHLBI of NIH R01HL141891, and R01HL151776, Phil Jenkins and Darlene & Stephen J. Szatmari Funds.