Prendes Carlota F, Spath Paolo, Khashram Manar, Dias Nuno, Furlan Federico, Gouveia E Melo Ryan, Gallitto Enrico, Sonesson Björn, Mendes Pedro Luis, Gormley Sinead, Gargiulo Mauro, Wanhainen Anders, Tsilimparis Nikolaos, Mani Kevin
Department of Vascular Surgery, Ludwig-Maximilians-University Hospital, Munich, Germany.
Section of Vascular Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
Ann Surg. 2025 Aug 1;282(2):328-338. doi: 10.1097/SLA.0000000000006300. Epub 2024 Apr 22.
With an increasing life expectancy, more octogenarian patients are referred with complex aortic aneurysms (cAAA). The aim of this study was to evaluate short and mid-term outcomes following fenestrated aortic repair (FEVAR) in octogenarians.
Few studies looking at octogenarian-specific outcomes with diverging results.
Retrospective, multicentre cohort study including consecutive patients undergoing elective FEVAR for cAAAs or type IV thoracoabdominal aortic aneurysms between 2007 and 2022 in 8 high-volume centres. Octogenarians versus nonoctogenarians were compared. The primary outcome was 30-day mortality. Secondary outcomes included 1-, 2-, and 5-year survival and reintervention rates.
A total of 729 patients [median age of 74.8 years (IQR: 69.2-79.14 years)] were included, 169 (23%) of which were octogenarians, with 316 (43.3%) patients undergoing juxtarenal/pararenal aneurysm repair. Although octogenarians presented less complex but larger (61 vs 58 mm) aneurysms, the number of fenestrations was similar across groups. No differences in in-hospital mortality (4.1% vs 3.0%), MAE (16.6% vs 12.2%) or reintervention rates (11.2% vs 10%) were found. Multivariable logistic regression of in-hospital mortality identified BMI (OR=0.66, 95% CI: 0.51-0.95, P =0.003), chronic heart failure (OR=7.70, 95% CI: 1.36-36.15, P =0.003), and GFR<45 mL/min/1.73 m 2 (OR=5.25, 95% CI: 1.20-22.86, P =0.027) as independent predictors. Median follow-up was 41 months. The 1-, 2-, and 5-year survival rates were 91.3%, 81.8%, and 49.5% in octogenarians versus 90.6%, 86.5%, and 68.8% in nonoctogenarian patients (log-rank=0.001). Freedom from aortic-related death and freedom from reintervention at 5 years were similar across groups (log-rank=0.94 and 0.76, respectively). Age above 80 years was not an independent predictor of 30-day or long-term mortality on multivariable and Cox regression analysis.
Elective FEVAR in octogenarians appears to be safe, with similar outcomes as in younger patients. Future studies looking at improved patient selection methods to ensure long-term survival benefits in both octogenarians and younger patients are warranted.
随着预期寿命的增加，越来越多的八旬老人因复杂主动脉瘤（cAAA）前来就诊。本研究的目的是评估八旬老人接受开窗主动脉修复术（FEVAR）后的短期和中期结果。
很少有研究关注八旬老人的特定结果，结果存在差异。
一项回顾性、多中心队列研究，纳入了2007年至2022年期间在8个高容量中心连续接受择期FEVAR治疗cAAA或IV型胸腹主动脉瘤的患者。比较了八旬老人和非八旬老人。主要结局是30天死亡率。次要结局包括1年、2年和5年生存率以及再次干预率。
共纳入729例患者[中位年龄74.8岁（IQR：69.2 - 79.14岁）]，其中169例（23%）为八旬老人，316例（43.3%）患者接受了近肾/肾旁动脉瘤修复。尽管八旬老人的动脉瘤复杂性较低但更大（61对58mm），但各组开窗数量相似。在住院死亡率（4.1%对3.0%）、主要不良事件（16.6%对12.2%）或再次干预率（11.2%对10%）方面未发现差异。住院死亡率的多变量逻辑回归确定BMI（OR = 0.66，95% CI：0.51 - 0.95，P = 0.003）、慢性心力衰竭（OR = 7.70，95% CI：1.36 - 36.15，P = 0.003）和肾小球滤过率<45 mL/min/1.73 m²（OR = 5.25，95% CI：1.20 - 22.86，P = 0.027）为独立预测因素。中位随访时间为41个月。八旬老人的1年、2年和5年生存率分别为91.3%、81.8%和49.5%，而非八旬老人患者分别为90.6%、86.5%和68.8%（对数秩检验 = 0.001）。5年时无主动脉相关死亡生存率和无再次干预生存率在各组间相似（对数秩检验分别为0.94和0.76）。在多变量和Cox回归分析中，80岁以上并非30天或长期死亡率的独立预测因素。
八旬老人接受择期FEVAR似乎是安全的，其结果与年轻患者相似。有必要开展未来研究，探索改进的患者选择方法，以确保八旬老人和年轻患者都能获得长期生存益处。
