Stent-Graft Repair versus Open Surgery for the Descending Aorta: A Case-Control Study

Abstract

Purpose:

To compare the clinical outcomes of open surgery versus endovascular repair in patients with pathologies of the descending thoracic aorta (DTA).

Methods:

This retrospective study included 44 patients (28 men; mean age 68±12 years, range 37–86) treated for DTA pathologies between 1995 and 2003. Twenty-two patients (15 men; mean age 68±13 years, range 37–86) undergoing stent-graft implantation were matched for sex, age, emergency operation, and comorbidities (coronary artery disease, chronic obstructive pulmonary disease) with a 22-patient contemporaneous surgical cohort (13 men; mean age 69±11 years, range 41–80).

Results:

Thirty-day mortality was 5% in the stent-graft group and 27% in the open surgery group (p=0.047). The incidences of postoperative stroke and paraplegia were both 5% in the stent-graft group and 9%, respectively, in the open surgery cohort. One patient required a second stent-graft due to an endoleak during the same hospital stay, and 2 reoperations were performed in the standard operation group (p = NS). Lengths of stay in the intensive care unit (ICU) and hospital were 4.3±5.4 and 11.9±15.0 days, respectively, in the stent-graft group and 10.0±7.4 and 21.5±17.4 days, respectively, in the open surgery group (p<0.006).

Conclusions:

Stent-graft repair was associated with lower 30-day mortality and comparable complication rates in older patients with significant comorbidities and a high percentage of emergency operations compared to open surgery. Stent-graft implantation shortens ICU and hospital stays significantly. In the future, subgroups of patients who may experience the greatest benefit from stent-graft repair in the long term should be defined.