Abstract 12173: TEVAR versus Open Descending Thoracic Aortic Repair for the Treatment of Thoracic Aortic Aneurysms: An Analysis of the Medicare Database
Introduction: Treatment of aneurysms of the descending thoracic aortic (TAA) was revolutionized with thoracic endovascular aortic repair (TEVAR). Whether TEVAR or open descending thoracic aortic repair (ODTAR) is the most appropriate intervention for TAAs remains controversial.
Hypothesis: We hypothesized that TEVAR would be associated with improved early survival, but have an increased late hazard phase of death compared with ODTAR.
Methods: We reviewed Medicare patients with a TAA undergoing ODTAR (n= 1037) and TEVAR (n=2010) but no concomitant operation from 1999-2010. CPT codes were used to identify procedural characteristics. Survival distributions were estimated with the Kaplan-Meier method; the log-rank test was used to compare differences between distributions. Analyses were repeated with using inverse probability of treatment weighting (IPTW) analysis to account for differences between groups. A flexible parametric analysis was used to model the time varying hazard of TEVAR compared with ODTAR.
Results: TEVAR recipients were older and had a higher incidence of all comorbidities compared with ODTAR recipients. Propensity scores were generated for both groups and are shown for the unweighted (Figure 1A) and weighted (Figure 1B) comparisons. After performing IPTW, all differences in age, demographics, comorbidities, and hospital characteristics were accounted for. There was a clear early survival advantage to TEVAR as compared to ODTAR in both the unweighted (Figure 1C) and weighted (Figure 1D) comparisons. However the late hazard of death for TEVAR was higher than for ODTAR, even after controlling for comorbidities, hospital, and operative characteristics (Figure 1E).
Conclusions: TEVAR is a reasonable alternative to ODTAR in TAA patients for whom anatomic constraints allow it. However, the late hazard of death remains higher in TEVAR recipients compared to ODTAR recipients, presumably because ODTAR provides a more durable repair.
Author Disclosures: J.M. Schaffer: None. B. Lingala: None. M.P. Fischbein: Research Grant; Significant; AHA Grant in Aid, National Marfan Foundation Grant. Y.J. Woo: None. R.S. Mitchell: None. D.C. Miller: None. M.D. Dake: None.
- © 2014 by American Heart Association, Inc.