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J Thorac Cardiovasc Surg 2008;135:1103-1109
© 2008 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Risk factors for early and late mortality after thoracic endovascular aortic repair

^a Section of Cardiovascular and Thoracic Surgery, University of Nebraska Medical Center, Omaha, Neb
^b Division of Vascular and Endovascular Surgery, Harbor-UCLA Medical Center, Torrance, Calif
^c Division of Interventional Radiology, Harbor-UCLA Medical Center, Torrance, Calif

Received for publication July 15, 2007; revisions received August 25, 2007; accepted for publication September 11, 2007.

^_* Address for reprints: Ali Khoynezhad, MD, PhD, Section for Thoracic and Cardiovascular Surgery, University of Nebraska Medical Center, 982315 Nebraska Medical Center, Omaha, NE 68198-2315. (Email: akhoynezhad{at}unmc.edu).

Objective: The risk factors associated with death after thoracic endovascular aortic repair are poorly understood. The aim of this study is to analyze the risk factors associated with early and late mortality after thoracic endovascular aortic repair.

Methods: A total of 153 patients underwent 184 thoracic endovascular aortic repairs between 1998 and 2005. Prospectively collected data were entered into statistical software. Univariate and multivariate analyses were performed.

Results: The underlying pathologies included descending thoracic aortic aneurysm (n = 91), acute type B aortic dissection (n = 25), chronic type B aortic dissection (n = 42), aortic transection (n = 12), and penetrating aortic ulcer (n = 14). Thoracic endovascular aortic repair was technically successful in all but 3 patients. Another 3 patients required an open repair within the first month. Early and late mortality rates were 9.8% (n = 18) and 19% (n = 35) in a 16-month average period of follow-up, respectively. Type I procedural endoleak was the only significant predictor of early death in the multivariate model (P = .0036; odds ratio: 8.4; 95% confidence interval: 1.6–43.9). Multivariate Cox regression revealed chronic obstructive pulmonary disease (P = .024; odds ratio: 3.8; 95% confidence interval: 1.2–12.1), postoperative myocardial infarction (P = .0053; odds ratio: 9.7; 95% confidence interval: 2.0–48.4), and acute renal failure (P = .0006; odds ratio: 22.8; 95% confidence interval: 3.8–137.6) to be independent risk factors for late mortality.

Conclusion: Procedural type I endoleak is an independent risk factor of early mortality after thoracic endovascular aortic repair. Chronic obstructive pulmonary disease, postoperative myocardial infarction, and acute renal failure are predictors of late death in the multivariate analysis.

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				A. Khoynezhad, C. E. Donayre, B. O. Omari, G. E. Kopchok, I. Walot, and R. A. White Midterm results of endovascular treatment of complicated acute type B aortic dissection J. Thorac. Cardiovasc. Surg., September 1, 2009; 138(3): 625 - 631. [Abstract] [Full Text] [PDF]