TEVAR Versus Open Repair Survival Rates Compared in the Medicare Population

December 13, 2011—Philip P. Goodney, MD, et al published a study that sought to describe the short- and long-term survival of patients with descending thoracic aortic aneurysms (TAAs) after open and endovascular repair (TEVAR) in Circulation (2011;124:2661–2669).

Based on Medicare claims from 1998 to 2007, the investigators analyzed patients who underwent repair of intact and ruptured TAAs, as identified from a combination of procedural and diagnostic International Classification of Disease (ninth revision) codes. The main outcome measure was mortality, which was defined as perioperative mortality (death occurring before hospital discharge or within 30 days), and 5-year survival by life-table analysis.

As detailed in Circulation, the investigators examined outcomes across repair type (open repair or TEVAR) in crude, adjusted (for age, sex, race, procedure year, and Charlson comorbidity score), and propensity-matched cohorts. They studied 12,573 Medicare patients who underwent open repair and 2,732 patients who underwent TEVAR.

The investigators found that perioperative mortality was lower in patients undergoing TEVAR compared with open repair for both intact (6.1% vs 7.1%; P = .07) and ruptured (28% vs 46%; P < .0001) TAAs. However, patients with intact TAAs who were selected for TEVAR had significantly higher mortality rates than patients who underwent open repair at 1 year (87% for open vs 82% for TEVAR; P = .001) and 5 years (72% for open vs 62% for TEVAR; P = .001). In adjusted and propensity-matched cohorts, patients who were selected for TEVAR had higher 5-year mortality rates than patients who were selected for open repair.

According to the investigators, although perioperative mortality is lower with TEVAR, Medicare patients who were selected for TEVAR had higher long-term mortality rates than patients who were selected for open repair. They concluded that the results of this observational study suggest that higher-risk patients are being offered TEVAR and that some do not benefit on the basis of long-term survival. Future research is needed to identify TEVAR candidates who are unlikely to benefit from repair, advised the investigators.