Advanced age is significantly associated with poor outcomes of thoracic endovascular aortic repair: a systematic review and meta-analysis.

Background: Whether advanced age is a risk factor for poor outcomes of thoracic endovascular aortic repair (TEVAR) remains unclear. This study aimed to evaluate the association between advanced age and outcomes after TEVAR.

Methods: To identify studies regarding TEVAR and age, the PubMed and Web of Science databases were systematically searched in July 2023. The associations between advanced age and outcomes of TEVAR for individuals with any types of thoracic aortic diseases were assessed according to the odds ratio (OR) or hazard ratio (HR). The ages of patients who suffered from adverse events after TEVAR were also compared. Study quality was assessed by using the Newcastle‒Ottawa Scale.

Results: A total of 70 studies with 52,605 patients were included in this meta-analysis. All enrolled studies were considered high-quality. Overall, advanced age was significantly associated with higher risk of postoperative mortality (p < 0.0001) and neurological complications (p = 0.006), especially delirium (p = 0.009), spinal cord ischemia (p = 0.02) and overall neurological complications (p = 0.007). Notably, the age of patients experiencing postoperative stroke was slightly older than those did not (p = 0.05). However, advanced age was not significantly associated with an elevated risk of postoperative overall complications (p = 0.59) or adverse aortic remodeling events (p = 0.34), including aortic dilation (p = 0.43) or false lumen dilation (p = 0.52). Moreover, patients who experienced acute kidney injury after TEVAR were significantly younger than those who did not (p = 0.04).

Conclusion: Advanced age is associated with poor outcomes of TEVAR, including postoperative mortality and neurological complications, though overall complications and aortic remodeling outcomes are similar. Additionally, AKI was even more frequent in younger patients. It is important to evaluate risk and benefit before deciding to perform TEVAR on older patients. Optimized peri-operative management should be developed and provided for older patients.