Early and mid-term outcomes of endovascular and open surgical repair of non-dissected aortic arch aneurysm†

Abstract

Objectives: With the introduction of endovascular stent graft technology, a variety of surgical options are available for patients with aortic aneurysms. We sought to evaluate early-term and mid-term outcomes of patients undergoing endovascular and open surgical repair for non-dissected aortic arch aneurysm.

Methods: Overall, 200 patients underwent treatment for isolated non-dissected aortic arch aneurysm between January 2008 and February 2016: 133 patients had open surgery and 67, endovascular repair. Early-term and mid-term outcomes were compared.

Results: Seventy percent ( n = 47) needing endovascular repair underwent fenestrated stent graft and 30% ( n = 20) underwent the debranched technique. Patients in the open surgery group were younger (71 vs 75 years, P < 0.001) and had a lower prevalence of ischaemic heart disease (11% vs 35%, P < 0.001). Intensive care unit stay (1 vs 3 days, P < 0.001), hospital stay (11 vs 17 days, P < 0.001) and surgical time (208 vs 390 min, P < 0.001) were lower in the endovascular repair group than in the open surgery group. There were 3 in-hospital deaths each in the open surgery and endovascular groups (2% vs 5%, respectively, P = 0.40). Mid-term survival ( P < 0.001) and freedom from reintervention ( P = 0.009) were better in the open surgery than in the endovascular repair group. No aneurysm-related deaths were observed. The propensity-matched comparison ( n = 58) demonstrated that survival was better in the open surgery group ( P = 0.011); no significant difference was seen in the reintervention rate ( P = 0.28).

Conclusions: Close follow-up for re-intervention may reduce the risk for aneurysm-related deaths and provide acceptable outcomes in patients undergoing endovascular repair.

Keywords: Aortic arch aneurysm; Fenestrated stent graft; Open surgery; TEVAR.