MOTHER Data Show Aortic Pathology Determines Midterm Outcome After TEVAR

February 12, 2013—A report from the Medtronic Thoracic Endovascular Registry (MOTHER) database was published by Benjamin Patterson, MD, et al in Circulation (2013;127:24–32).

According to the investigators, as thoracic endovascular aorta repair (TEVAR) has become an increasingly utilized therapy, the short-term mortality advantage over open surgery is well documented; however, late mortality and the impact of presenting pathology on long-term outcomes remain poorly reported.

As summarized in Circulation, a database was built from five prospective studies and a single institutional series. Rates of perioperative adverse events were calculated, as were midterm death and reintervention rates. Multivariate analysis was performed with the use of logistic regression modeling. Kaplan-Meier survival curves were drawn for midterm outcomes.

The database contained 1,010 patients: 670 patients with thoracic aortic aneurysm, 195 with chronic type B aortic dissection, and 114 with acute type B aortic dissection. Lower elective mortality was observed in patients with chronic dissections (3%) compared with patients with aneurysms (5%). Multivariate analysis identified age, mode of admission, American Society of Anesthesiologists grade, and pathology as independent predictors of 30-day death (P < .05).

In the midterm, the all-cause mortality rates were 8, 4.9, and 3.2 deaths per 100 patient-years for thoracic aortic aneurysm, acute type B aortic dissection, and chronic type B aortic dissection, respectively. The rates of aortic-related death were 0.6, 1.2, and 0.4 deaths per 100 patient-years for thoracic aortic aneurysm, acute type B aortic dissection, and chronic type B aortic dissection, respectively.

The study indicated that the midterm outcomes of TEVAR are defined by presenting pathology, associated comorbidities, and mode of admission. Nonaortic mortality is high in the midterm for patients with thoracic aortic aneurysm, and managing modifiable risk factors appears vital. TEVAR results in excellent midterm protection from aortic-related mortality, regardless of presenting pathology, concluded the investigators in Circulation.

"The MOTHER database is an exciting opportunity to study a large cohort of patients who have undergone TEVAR for a variety of problems," stated Dr. Patterson, from St. George's Vascular Institute in London. "We have demonstrated that TEVAR prevents aortic death effectively in both aneurysm and dissection patients at midterm follow-up, but this is not the whole story. Improved patient selection and better postoperative risk-factor management may help to improve the high all-cause death rate seen in aneurysm patients at follow-up, and detailed analysis of the dissection patients may help to understand how we can reduce the aortic reintervention rate."