Abstract 15289: Phase-Specific Survival After Endovascular versus Open Surgical Repair of Descending Thoracic Aortic Aneurysm

Background: Thoracic endovascular aortic repair (TEVAR) has gained preference over open surgical repair (OSR) as the intervention of choice for patients with descending thoracic aortic aneurysm (DTA). However, recent studies have suggested comparable or potentially favorable outcomes after OSR. This study aimed to compare the outcomes of patients with DTA undergoing OSR and TEVAR with contemporary findings.

Methods: A comprehensive search of MEDLINE and EMBASE databases was conducted to identify relevant randomized controlled trials or studies utilizing propensity-score analysis or reporting risk-adjusted outcomes. The search was performed up until March 2023. All-cause mortality was analyzed in specific phases: within 1 year, 1-2 years, and beyond 2 years.

Results: Eight studies met the inclusion criteria, including 4 studies using propensity-score matching and 4 studies reporting risk-adjusted outcomes, comprising 14,873 patients with DTA undergoing OSR (n=10,882) and TEVAR (n=3,991). No randomized controlled trials were identified. Operative mortality was similar between the two interventions (odds ratio 0.92, 95% CI 0.70-1.21, p = .57, I ² = 0%). However, overall long-term mortality was significantly higher after TEVAR compared to OSR (hazard ratio (HR) 1.30, 95% CI 1.05-1.59, p = .01, I ² = 0%). Phase-specific analysis revealed comparable risks of mortality within 1 year and between 1 and 2 years after interventions, while the risk of mortality was significantly higher after TEVAR compared to OSR beyond 2 years (HR 1.77, 95% CI, 1.19-2.63, p = .01. I ² = 0%).

Conclusion: This study demonstrated comparable operative mortality between OSR and TEVAR, but higher long-term mortality associated with TEVAR in patients with DTA. The phase-specific analysis highlighted the survival advantage of OSR beyond 2 years after surgery compared to TEVAR. These findings suggest a need for reconsidering OSR indications in the management of DTA.