Outcomes of Fenestrated-Branched Endovascular Aortic Repair in Octogenarians are Comparable to Non-octogenarians
Jussi M. Karkkainen, MD PhD, Emanuel R. Tenorio, MD PhD, Bernardo C. Mendes, MD, Randall R. DeMartino, MD, Jean Wigham, RN, Alisa Diderrich, RN, Jan Hofer, RN, Gustavo S. Oderich, MD.
Mayo Clinic, Rochester, MN, USA.
Objective: To evaluate outcomes of fenestrated-branched endovascular aortic repair (F-BEVAR) of pararenal and thoracoabdominal aortic aneurysms in octogenarians as compared to non-octogenarians. Methods: We reviewed the clinical data of 442 consecutive patients treated by F-BEVAR between 2007-2018. Patients were divided into two groups, octogenarians (age ≥80 years) and non-octogenarians (age <80 years). End-points included 30-day mortality and major adverse events (MAEs), length of hospital stay, discharge status and late survival, freedom from reinterventions and freedom from target vessel instability. Multivariate Cox regression analysis was used to identify independent predictors of late mortality. Results: There were 138 octogenarians (73% male, mean age 84±3 years) and 304 non-octogenarians (75% male, mean age 71±6). Patients in both groups had similar clinical characteristics, aneurysm extent and procedural variables, with the exception of more stage III to V chronic kidney disease (41% vs 28%, P=0.008) among octogenarians, and more cigarette smoking (91% vs 80%, P=0.003), chronic pulmonary disease (54% vs 38%, P=0.001) and higher SVS pulmonary scores (2.6±2.1 vs 2.0±1.9, P=0.004) among non-octogenarians. The 30-day mortality was 2.2% vs 2.0% (P=0.99) and the rate of MAEs was 31% versus 30% (P=0.91) in octogenarians versus non-octogenarians, respectively. Median length of hospital stay was similar in both groups (5 days, interquartile range 3-8), but discharge to home was more frequent among non-octogenarians (84% vs 70%, P=0.001). The mean follow-up was 2.9±2.2 years. At 5-years, there were no significant difference in patient survival (44±6% vs 59±4%, P=0.080), freedom from reinterventions (48±10% vs 61±6%, P=0.11) and freedom from target vessel instability (68±9% vs 74±7%, P=0.33) between octogenarians and non-octogenarians. Patient survival was lower for octogenarians when compared to patients younger than 70-years-old (44±6% vs 62±8% at 5 years, P=0.025, Figure). Independent predictors for late mortality (P<0.05) were age >70 years, ejection fraction <30%, MAE, higher ASA score and blood loss. Conclusions: Outcomes of F-BEVAR in octogenarians were nearly identical to non-octogenarians with low 30-day mortality (2.1%) and no difference in rate of MAEs. Factors associated with higher long-term mortality included age >70 years, low ejection fraction, MAE, higher ASA score and blood loss.
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