Department of Interventional Cardiology, Tehran Heart Center Hospital, Tehran University of Medical Sciences, Tehran, Iran; Tehran Heart Center, Cardiovascular Diseases Research Institue, Tehran University of Medical Sciences, Tehran, Iran.
Department of Interventional Cardiology, Tehran Heart Center Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Cardiovasc Revasc Med. 2023 Jun;51:23-30. doi: 10.1016/j.carrev.2023.01.020. Epub 2023 Jan 30.
Studies on the mid and long-term outcomes of thoracic endovascular aortic repair (TEVAR) are scarce. This study aimed to investigate the long-term outcomes of TEVAR for all-comers patients with various types of thoracic aortic pathologies, predominantly thoracic aortic dissections and thoracic aortic aneurysms.
Between January 2005 and December 2015, 123 consecutive patients with thoracic aortic pathologies underwent TEVAR. The patients were divided into groups based on aortic pathologies (dissections or aneurysms) and the type of procedure (hybrid TEVAR or non-hybrid TEVAR). Mortality, complications, and reintervention rates were compared between these four groups. The Kaplan-Meier curve and the Cox regression analysis were employed to estimate survivals and factors associated with 5-year mortality.
One hundred twenty-three consecutive patients with various aortic pathologies undergoing TEVAR were evaluated. Hypertension (79.7 %) and smoking (39 %) were the most common comorbidities in the study population. The patients were followed up for a mean duration of 58.1 ± 7.1 months to evaluate the postprocedural surveillance. Most complications occurred in the dissection and hybrid groups; however, these differences were nonsignificant. The overall 5-year surveillance and reintervention rates were 65 % and 12.1 %, respectively. A significant difference existed in 5-year survival between the patients with aneurysmal and aortic dissection pathologies based on the log-rank test (P = 0.01). On the other hand, no significant differences were observed in 5-year survival between the patients who underwent hybrid and non-hybrid TEVAR. The Cox regression analysis confirmed that chronic kidney disease, previous coronary artery bypass grafting, age >65 years, platelet counts <150∗ 10/μL, aneurysmal aortic pathology, and ejection fraction ≤ 50 % were predictors of 5-year mortality.
The long-term outcomes of TEVAR for various aortic pathologies disclosed that this procedure was well-tolerated in a group of patients with high comorbid conditions. The five-year survival rate of TEVAR for thoracic aortic dissections was more favorable than that for thoracic aortic aneurysms, but there were no significant differences between hybrid and non-hybrid procedures regarding the mortality rate.
关于胸主动脉腔内修复术（TEVAR）的中期和长期结果的研究很少。本研究旨在调查 TEVAR 治疗各种类型胸主动脉病变（主要是胸主动脉夹层和胸主动脉瘤）患者的长期结果。
2005 年 1 月至 2015 年 12 月，123 例胸主动脉病变患者连续接受 TEVAR 治疗。根据主动脉病变（夹层或动脉瘤）和手术类型（杂交 TEVAR 或非杂交 TEVAR）将患者分为两组。比较这四组之间的死亡率、并发症和再干预率。采用 Kaplan-Meier 曲线和 Cox 回归分析估计生存率和与 5 年死亡率相关的因素。
连续 123 例不同主动脉病变的患者接受了 TEVAR 治疗。研究人群中最常见的合并症是高血压（79.7%）和吸烟（39%）。对这些患者进行了平均 58.1±7.1 个月的随访，以评估术后监测情况。大多数并发症发生在夹层和杂交组中，但差异无统计学意义。总的 5 年监测和再干预率分别为 65%和 12.1%。根据对数秩检验，主动脉瘤和主动脉夹层患者的 5 年生存率存在显著差异（P=0.01）。另一方面，杂交和非杂交 TEVAR 患者的 5 年生存率无显著差异。Cox 回归分析证实慢性肾脏病、既往冠状动脉旁路移植术、年龄>65 岁、血小板计数<150∗10/μL、主动脉瘤病理和射血分数≤50%是 5 年死亡率的预测因素。
各种主动脉病变 TEVAR 的长期结果表明，对于一组合并症较高的患者，该手术耐受良好。TEVAR 治疗胸主动脉夹层的 5 年生存率优于胸主动脉瘤，但在死亡率方面，杂交与非杂交手术之间无显著差异。
