Key result
TEVAR in octogenarians is linked to ~2-fold higher 5-year mortality compared to open repair.
Why the study?
Thoracic endovascular aortic repair (TEVAR) offers a less invasive alternative to open repair in high-risk populations, but comparative short- and long-term outcomes in octogenarians remain poorly characterized.
Does thoracic endovascular aortic repair (TEVAR) improve short- and long-term all-cause mortality and clinical outcomes compared to open thoracic aortic repair in octogenarians?
Observational (n=1,076)
Yes
Does thoracic endovascular aortic repair (TEVAR) improve short- and long-term all-cause mortality and clinical outcomes compared to open thoracic aortic repair in octogenarians?
In octogenarians undergoing thoracic aortic repair, TEVAR yields similar short-term survival and fewer perioperative transfusions compared to open repair, but is associated with substantially higher long-term mortality, graft complications, and ICU utilization.
Background Thoracic endovascular aortic repair (TEVAR) offers a less invasive alternative to open repair in high-risk populations, but comparative outcomes in octogenarians remain poorly characterized. Purpose To compare short- and long-term outcomes between TEVAR and open thoracic aortic repair in patients aged ≥80 years. Methods Octogenarians undergoing TEVAR or open repair were identified from the TriNetX US Collaborative Network. Propensity-score matching (1:1) balanced age, sex, race, ethnicity, hypertension, BMI, and tobacco dependence. Outcomes included all-cause mortality (30-day, 90-day, 1-year, 5-year, anytime), graft complications, ICU stay, blood transfusion, acute kidney injury, pneumonia, and respiratory failure. Hazard ratios (HR) and risk ratios (RR) with 95% confidence intervals were calculated. Results Among 2,705 octogenarians (802 TEVAR, 1,903 open repair), propensity matching yielded well-balanced cohorts (n=538 each). After matching, TEVAR was associated with significantly higher long-term mortality: 1-year (HR 1.714, 95% CI 1.246-2.358; RR 1.700), 5-year (HR 2.028, 95% CI 1.561-2.634; RR 1.764), and any-time mortality (HR 1.947, 95% CI 1.540-2.462; RR 1.346). However, 30-day (HR 0.901, 95% CI 0.587-1.383) and 90-day mortality (HR 1.396, 95% CI 0.978-1.992) were not significantly different. TEVAR was associated with increased graft complications at 1 year (HR 2.543, 95% CI 1.335-4.346; RR 2.467) and ICU stay at 1 year (HR 1.847, 95% CI 1.297-2.629; RR 1.791). TEVAR conferred lower risk of 30-day blood transfusion (HR 0.236, 95% CI 0.135-0.415; RR 0.252). No significant differences were observed for acute kidney injury, pneumonia, or respiratory failure. Conclusion In octogenarians, TEVAR is associated with comparable 30- and 90-day mortality but higher long-term mortality, increased graft complications, and greater ICU utilization compared to open repair, despite reduced perioperative transfusion requirements. These findings suggest that the initial benefits of TEVAR must be weighed against substantially worse long-term outcomes in this elderly population.
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Hammadeh et al. (2026) conducted an observational in Thoracic aortic disease requiring repair (n=1,076). Thoracic endovascular aortic repair (TEVAR) vs. Open thoracic aortic repair was evaluated on All-cause mortality (5-year) (HR 2.028, 95% CI 1.561-2.634). TEVAR in octogenarians was associated with significantly higher 5-year mortality (HR 2.028; 95% CI 1.561-2.634) and 1-year graft complications (HR 2.543) compared to open repair.
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