Thoracic Endovascular Aortic Repair in Octogenarian. A Single Center Retrospective Analysis.

S. Mosbahi¹, J. Bavaria², M. Berezowski³, J. J. Kelly³, N. J. Goel³, f. jiang³, B. Cannon³, D. Schneider³, w. grace⁴, W. Szeto³, N. D. Desai^3
1University of Pennsylvania Health System, Philadelphia, Pennsylvania ²Hospital of the University of Pennsylvania, Dept. of Cardiovascular S, Philadelphia, Pennsylvania ³University of Pennsylvania, Philadelphia, Pennsylvania ⁴Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania

Purpose: As the elderly population expands, the number of thoracic endovascular aortic repairs (TEVARs) performed on individuals in their 80s and 90s is also rising, as well as the pertinent questions regarding surgical outcomes within these populations. In this context, we discuss our institution's experience with TEVARs in this population.

Methods: Medical records of 1298 patients that underwent TEVAR at a single institution between 2002 and 2022 were retrospectively reviewed. Two hundred and thirty-four patients were 80 years old or older at the time of TEVAR (>80), while 1063 were under 80 years old ( < 80). The determinants of 30-day mortality were estimated using a multivariable analysis through logistic regression. Each group was stratified according to the degree of urgency (urgent or elective), and a subgroup survival analysis using the Kaplan-Meier method was conducted.

Results: Characteristics of both groups are summarized in table 1.
Survival analysis of the elective subgroup is depicted in figure 1.
In the multivariable analysis emergency and preoperative instability were predictive of factor of 30-day mortality with OR 4.8 [95%CI, 1.5-7.2] and OR:3.4 [1.5-7.2] respectively. However male gender and age>80 did not significantly impact in hospital survival: OR: 0.8 [0.5-1.3] and 0.6 [0.4-1.1].
Overall survival in percent with standard error at 6months 1, 2 and 5 years after a TEVAR procedure < 80: 89±0.98; 86.97±1.1; 81.1±1.3; 67.2±1.7, and in patients >80: 79.8±2.7; 74.9±2.9; 65.8±3.3; 37.4±3.8
Survival at 6months, 1, 2 and 5 years after an elective TEVAR for the patients < 80 was: 92.7±1.1; 89.1±1.3; 84.3±1.6; 66.8±2.3, and in patients >80: 88.6±2.7; 84.1±3.1; 74.2±3.8; 42.3±4.9.
Survival at 6months, 1, 2 and 5 years after an urgent TEVAR for the patients < 80 was: 83.5±1.8; 81.4±1.9; 76.4±2.2; 66.6±2.5, and in patients >80: 65.4±5.3; 58.2±5.6; 51.7.2±5.8; 26.5±6.

Conclusion: In hospital survival was not affected by advanced age. The TEVAR procedure shows a correlation between age and survival rates mostly in urgent cases, with patients over 80 experiencing a marked decrease in survival compared to those under 80. However, when considering up to two years postoperative for elective cases, the survival difference between both age groups is negligible, highlighting the effectiveness of elective TEVAR procedures in all ages and thereby emphasizing the importance of preventive strategies and early elective intervention where possible. Advanced age should not be seen as a disqualifying factor for elective TEVAR.

Identify the source of the funding for this research project: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors