Impact of the urgency and the landing zone on rates of in-hospital death, stroke, and paraplegia following thoracic endovascular aortic repair in Japan.

Abstract Objective This study used data from the Japanese Committee for Stentgraft Management’s national registry, which contained unique surgical data including the surgical timing, anatomical factors, and pathological factors, to reveal the generalized community experience of thoracic endovascular aortic repair (TEVAR). Methods The medical background and short-term outcomes were demonstrated in patients who had undergone TEVAR for a thoracic aortic aneurysm (TAA; 14,235 cases) or aortic dissection (AD; 990 and 4,259 cases for types A and B, respectively) between 2008 and 2015. TEVAR for AD was separated from TAA; only background and short-term outcomes were demonstrated. The technical outcomes of TEVAR for TAA were evaluated. All the cases were categorized as follows: elective, urgent (within 24 hours after admission), or emergent (immediately after admission). The outcomes included in-hospital mortality, persistent stroke, and paraplegia that were diagnosed at discharge. The number of debranching bypasses, the proximal landing zone (0, 1, 2, 3∼), and the length of the zone were included in the logistic regression analysis. Results The mortality, stroke, and paraplegia rates in the TAA and AD groups were 4.4%, 4.6%, and 3.7% and 4.0%, 2.9%, and 2.8%, respectively. After analyzing the TAA cohort, we found that urgent and emergent cases were associated with all adverse outcomes. The rate of paraplegia increased drastically in the cases with stent graft coverage that extended over six zones. Massive atheroma was associated with stroke and paraplegia. The cumulative survival rate of the TAA group was stratified among the elective, urgent, and emergent cases (p Conclusions Urgency was strongly associated with mortality, stroke, and paraplegia, and the classification of “urgent” and “emergent,” according to the surgical timing after the admission, successfully stratified the population in the long-term overall survival analysis. The proximal landing zone involving the aortic arch and the debranched bypasses were associated with stroke, while the length of stent graft coverage over six zones was associated with paraplegia. Identifying these risk factors will help the operators of TEVAR develop an appropriate operative strategy to mitigate risk.