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TEVAR vs. Open Repair for Traumatic Thoracic Aortic Injury
Study Questions:
What are the long-term outcomes of thoracic endovascular aortic repair (TEVAR) and those of open repair (OR) for traumatic thoracic aortic injury (TAI)?
Methods:
The investigators conducted a nationwide cohort study using Taiwan’s National Health Insurance Database to evaluate patients with traumatic TAI between January 1, 2004, and December 31, 2013. This single-payer National Health Insurance program covered more than 99.9% of the Taiwanese population. Those who received open repair or TEVAR for TAI by propensity score matching were included. Data analysis was conducted in October 2017. The main outcomes and measures were in-hospital outcomes, all-cause mortality, aorta reintervention, and stroke during follow-up.
Results:
Of the 287 patients (mean [standard deviation (SD)] age, 41.66 [17.98] years; 80.5% male) who received open repair or TEVAR for TAI, propensity score matching yielded 100 patients each in the OR and TEVAR groups. After propensity score matching, in-hospital mortality risk was significantly lower in the TEVAR group (9 [9.0%]) than in the OR group (27 [27.0%]; TEVAR vs. open repair: odds ratio, 0.27; 95% CI, 0.12-0.60). With a mean (SD) follow-up of 2.80 (2.63) years, the proportion of survivors was 71.9% at 1 year, 70.8% at 2 years, 68.2% at 3 years, and 65.1% at 5 years in the OR group versus 88.9% at 1 year, 88.9% at 2 years, 88.9% at 3 years, and 88.9% at 5 years in the TEVAR group (log-rank test, p < 0.001). The TEVAR group had only two events (2%) of late reintervention and one event (1%) of late cerebrovascular accident. The proportion of freedom from reintervention was 100% at 1 year, 100% at 2 years, 100% at 3 years, and 100% at 5 years in the OR group versus 97.4% at 1 year, 97.4% at 2 years, 97.4% at 3 years, and 97.4% at 5 years in the TEVAR group (log-rank test, p = 0.18).
Conclusions:
The authors concluded that compared with open repair, TEVAR was associated with better long-term outcomes, mainly owing to lower mortality during the perioperative period.
Perspective:
This study reports better long-term outcome of TEVAR compared with that of open repair regarding TAI management, mainly owing to decreased mortality in the perioperative period. Furthermore, TEVAR was associated with similar rates of survival and reintervention after hospital discharge. Overall, these data suggest that TEVAR may be preferred to open repair for patients with TAI.
Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Prevention, Vascular Medicine, Aortic Surgery, Cardiac Surgery and Arrhythmias, Interventions and Vascular Medicine
Keywords: Aorta, Thoracic, Aortic Diseases, Cardiac Surgical Procedures, Cardiology Interventions, Endovascular Procedures, Hospital Mortality, Primary Prevention, Risk, Stroke, Survivors, Treatment Outcome, Vascular Diseases
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