Thoracic Endovascular Aortic Repair In Octogenarians And Nonagenarians: Functional Status Over Age
Akbarshakh Akhmerov, MD1, Halim Yammine, MD2, Cassra Arbabi, MD1, Jocelyn K. Ballast, BA2, Frank R. Arko, III, MD2, Aamir S. Shah, MD1, Allan W. Tulloch, MD1, Navyash Gupta, MD1, Bruce Gewertz, MD1, Ali Azizzadeh, MD1.
1Cedars-Sinai Medical Center, Los Angeles, CA, USA, 2Sanger Heart and Vascular Institute, Atrium Health, Charlotte, NC, USA.
OBJECTIVES: As a result of improved life expectancy, the oldest segments of the population are among the fastest growing in United States. The expanding number of thoracic endovascular aortic repairs (TEVAR) in patients ≥ 80 years of age parallels the national census. Although outcomes data are available for open thoracic aortic repairs in octogenarians, there are no data for TEVAR in this cohort. We report outcomes from a multi-institutional cohort of octo- and nonagenarian patients undergoing TEVAR.
METHODS: All patients ≥ 80 years of age undergoing TEVAR at two high-volume centers were reviewed, using prospectively maintained databases. Patient demographics, preoperative status, operative details, and postoperative outcomes were analyzed. The Kaplan-Meier method was used to analyze survival.
RESULTS: Seventy-five octo- and nonagenarians (age 84.0 ± 3.2 years, 52% female) underwent TEVAR between 2014 and 2019. The most common preoperative comorbidities were hypertension (n=66, 88%), tobacco use (n=24, 32%), and COPD (n=19, 25%). Nineteen patients (25%) had prior aortic interventions (n=14 open, n=10 endovascular). Aneurysms and dissections constituted the majority of diagnoses (48% and 47%, respectively), with a maximal aortic diameter of 68.6 ± 19.7 mm. Endoleaks were noted in 16 patients, including type 1 (12%), type 2 (8%), and type 3 (1%). Stroke was the most common postoperative complication (n=4, 5%); one patient (1.3%) experienced spinal ischemia. Nine patients (12%) required reintervention, predominantly for endoleaks (3/9) and malperfusion (3/9). There were no intraoperative mortalities. Thirty-day and one-year survival were 84% and 75%, respectively.
CONCLUSIONS: Despite the inherently elevated operative risk among elderly patients, this study demonstrates reasonable success rates in octo- and nonagenarians undergoing TEVAR. In properly selected patients, advanced age alone should not be a prohibitive factor for TEVAR. 
| ASA | 4.0 [3.0, 4.0] |
| Procedure time (min) | 154.8±111.0 |
| Fluoroscopy time (min) | 22.8±28.3 |
| Number of grafts (per patients) | 1.7±0.8 |
| Great vessel debranching | 14 (18.7) |
| Endoleaks | 16 (21.3) |
| Cerebrovascular accident | 4 (5.3) |
| Reintervention | 9 (12.0) |
| 30-day survival | 63 (84.0) |
| 1-year survival | 56 (74.7) |
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