Investigation of risk factors and outcomes of aortic arch aneurysm repair in octogenarians.

Objective: We reviewed the treatment outcomes for aortic arch aneurysms in elderly patients aged > 80 years, and discussed the risk factors for each technique.

Methods: Octogenarians who underwent aortic arch aneurysm repair between 2007 and 2021 were included. Fifty-four patients (23 in the total arch replacement [TAR] group and 31 in the thoracic endovascular aortic repair [TEVAR] group) were included in the study. The early- and mid-term outcomes and risk factors for all-cause mortality were examined in each group. To examine timely surgical outcomes, cases of true aneurysms were included, whereas dissected aneurysms and emergency cases due to rupture or other causes were excluded.

Results: No significant differences in 30-day mortality (0% in the TAR group and 5.4% in the TEVAR group) and in-hospital mortality (7.7% in the TAR group and 8.1% in the TEVAR group) were observed between the two groups. The survival rates at 5 years were 82% and 65% in the TAR and TEVAR groups, respectively, without significant difference. The aorta-related averted mortality was 91% and 81% in the TAR and TEVAR groups, respectively, without significant difference. No significant difference in the freedom from aortic events was also observed between the two groups. Previous ischemic heart disease was a significant risk factor for all-cause mortality in the TAR group. No significant risk factors were identified in this group.

Conclusion: The choice of procedure was reasonable when considering frailty. Endovascular repair may be a good treatment option for patients with a history of ischemic heart disease.