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Endovascular repair of the thoracic aorta in octogenarians

^a Arizona Heart Institute, Department of Cardiovascular and Endovascular Surgery, Phoenix, AZ, United States
^b Bayhealth Medical Center, Department of Cardiac Surgery, Dover DE affiliated with University of Pennsylvania Health System, Philadelphia, PA, United States

Received 13 September 2007; received in revised form 21 May 2008; accepted 26 May 2008.

^_* Corresponding author. Address: Hoag Heart and Vascular Institute, Hoag Presbyterian Memorial Hospital, 1 Hoag Drive, PO box 6100, Newport Beach, CA 92658-6100, Unites States. Tel.: +1 602 266 2200; fax: +1 602 604 5020. (Email: jkpodonu{at}yahoo.com).

Background: To evaluate the feasibility and safety of thoracic endografting in the octogenarian population. Methods: Between February 2000 and August 2005, 249 patients with a mean age of 69 ± 12.3 years (range 23–91) underwent thoracic endografting. Forty-four patients (27 males and 17 females) were octogenarians with a mean age of 84 ± 2.7 years. Indications for intervention included: atherosclerotic aneurysms (26/44, 59%), acute and chronic dissections (9/44, 20.5%), penetrating aortic ulcers (6/44, 14%) and contained rupture (3/44, 7%). Results: Endovascular repair was achieved in all octogenarian patients (44/44, 100%). Mean length of stay was 4.7 ± 3.6 days. Two cardiac-related deaths and 1 retrograde dissection death occurred (3/44, 7%). Complications included hemiparesis (n = 2) with full recovery at discharge, groin hematoma (n = 1), pneumonia (n = 2) and stroke (n = 1) [6/44, 11%]. Endoleaks were diagnosed in 3 patients [3/44, 7%] (2 type I, 1 type II) at 30-day follow-up. Two patients developed an endoleak beyond 30 days [2/44, 5%] (1 type I, 1 type II). Two re-interventions were necessary at 30 days (1 type I, 1 type II). Mean follow-up was 22 months and there were no device migrations or aortic ruptures. No statistical differences in overall mortality were noted between octogenarians and non-octogenarians at 30 days (7% vs 6%, p = NS), 12 months (18% vs 13%, p = NS) and 24 months (27% vs 15%, p = NS). However, at 5 years post-procedure, octogenarians had a significantly higher overall mortality than non-octogenarians (32% vs 17%, p = 0.038). Conclusions: Advanced age is not a contraindication to thoracic endografting with favorable short and mid-term outcomes compared to non-octogenarians.

Key Words: Octogenarian • Thoracic stent graft • Endovascular surgery