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Risk factors for 1-year mortality after thoracic endovascular aortic repair.

Publication ,  Journal Article
Shah, AA; Craig, DM; Andersen, ND; Williams, JB; Bhattacharya, SD; Shah, SH; McCann, RL; Hughes, GC
Published in: J Thorac Cardiovasc Surg
May 2013

OBJECTIVE: Thoracic endovascular aortic repair, although physiologically well tolerated, may fail to confer significant survival benefit in some high-risk patients. In an effort to identify patients most likely to benefit from intervention, the present study sought to determine the risk factors for 1-year mortality after thoracic endovascular aortic repair. METHODS: A retrospective review was performed on prospectively collected data from all patients undergoing thoracic endovascular aortic repair from 2002 to 2010 at a single institution. Univariate analysis and multivariate Cox proportional hazards regression analysis were used to identify risk factors associated with mortality within 1 year after thoracic endovascular aortic repair. RESULTS: During the study period, 282 patients underwent at least 1 thoracic endovascular aortic repair; index procedures included descending aortic repair (n = 189), hybrid arch repair (n = 55), and hybrid thoracoabdominal repair (n = 38). The 30-day/in-hospital mortality was 7.4% (n = 21) and the overall 1-year mortality was 19% (n = 54). Cardiopulmonary pathologies were the most common cause of nonperioperative 1-year mortality (22%, n = 12). Multivariate modeling demonstrated 3 variables independently associated with 1-year mortality: age older than 75 years (hazard ratio, 2.26; P = .005), aortic diameter greater than 6.5 cm (hazard ratio, 2.20; P = .007), and American Society of Anesthesiologists class 4 (hazard ratio, 1.85; P = .049). A baseline creatinine greater than 1.5 mg/dL (hazard ratio, 1.79; P = .05) and congestive heart failure (hazard ratio, 1.87; P = .08) were also retained in the final model. These 5 variables explained a large proportion of the risk of 1-year mortality (C statistic = 0.74). CONCLUSIONS: Age older than 75 years, aortic diameter greater than 6.5 cm, and American Society of Anesthesiologists class 4 are independently associated with 1-year mortality after thoracic endovascular aortic repair. These clinical characteristics may help risk-stratify patients undergoing thoracic endovascular aortic repair and identify those unlikely to derive a long-term survival benefit from the procedure.

Duke Scholars

Published In

J Thorac Cardiovasc Surg

DOI

EISSN

1097-685X

Publication Date

May 2013

Volume

145

Issue

5

Start / End Page

1242 / 1247

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Time Factors
  • Risk Factors
  • Risk Assessment
  • Retrospective Studies
  • Respiratory System
  • Proportional Hazards Models
  • Postoperative Complications
  • North Carolina
  • Multivariate Analysis
 

Citation

APA
Chicago
ICMJE
MLA
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Shah, A. A., Craig, D. M., Andersen, N. D., Williams, J. B., Bhattacharya, S. D., Shah, S. H., … Hughes, G. C. (2013). Risk factors for 1-year mortality after thoracic endovascular aortic repair. J Thorac Cardiovasc Surg, 145(5), 1242–1247. https://doi.org/10.1016/j.jtcvs.2012.05.005
Shah, Asad A., Damian M. Craig, Nicholas D. Andersen, Judson B. Williams, Syamal D. Bhattacharya, Svati H. Shah, Richard L. McCann, and G Chad Hughes. “Risk factors for 1-year mortality after thoracic endovascular aortic repair.J Thorac Cardiovasc Surg 145, no. 5 (May 2013): 1242–47. https://doi.org/10.1016/j.jtcvs.2012.05.005.
Shah AA, Craig DM, Andersen ND, Williams JB, Bhattacharya SD, Shah SH, et al. Risk factors for 1-year mortality after thoracic endovascular aortic repair. J Thorac Cardiovasc Surg. 2013 May;145(5):1242–7.
Shah, Asad A., et al. “Risk factors for 1-year mortality after thoracic endovascular aortic repair.J Thorac Cardiovasc Surg, vol. 145, no. 5, May 2013, pp. 1242–47. Pubmed, doi:10.1016/j.jtcvs.2012.05.005.
Shah AA, Craig DM, Andersen ND, Williams JB, Bhattacharya SD, Shah SH, McCann RL, Hughes GC. Risk factors for 1-year mortality after thoracic endovascular aortic repair. J Thorac Cardiovasc Surg. 2013 May;145(5):1242–1247.
Journal cover image

Published In

J Thorac Cardiovasc Surg

DOI

EISSN

1097-685X

Publication Date

May 2013

Volume

145

Issue

5

Start / End Page

1242 / 1247

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Time Factors
  • Risk Factors
  • Risk Assessment
  • Retrospective Studies
  • Respiratory System
  • Proportional Hazards Models
  • Postoperative Complications
  • North Carolina
  • Multivariate Analysis