Combination of Mural Thrombus and Age Improves the Identification of All-Cause Mortality Following Branched Endovascular Repair.

Abstract Introduction In-hospital and 30-day mortality rates of endovascular repair of thoracoabdominal aortic aneurysms (TAAA) shows a significant improvement over open surgery although we are not seeing a significant difference at one year. We assess the hypothesis that a greater mural thrombus ratio within the aorta could function as an indicator of post-operative mortality. Methods The mural thrombus ratio and pre-operative comorbidities of 100 consecutive patients from a single center undergoing endo-debranching between 2012 and 2019 were evaluated. Logistic regression, survival analysis, and decision tree methods were utilized to examine each variable’s association with death at one year. Results At the time of analysis, 73 subjects had one-year outcomes and adequate imaging to assess the parameters. At one-year the overall survival for all subjects was 71.2% (21 died, 52 survived). For patients with a favorable mural thrombus ratio (n=36), the overall one-year survival was 86.1% (5 died, 31 survived). The subjects with an unfavorable mural thrombus ratio (n=37), had an overall 1 year survival of 56.8% (16 died, and 21 survived). The only pre-operative mortality factor that was statistically significant between the subjects with an unfavorable mural thrombus ratio was age of the patient. The survival for subjects > 75 years with an unfavorable mural thrombus ratio was 90% (1 died, 9 survived) versus only 44.4% survival for subjects Conclusions This study examined whether a patient’s mural thrombus ratio may be an indicator of one-year survival. These findings suggest that the combination of a patient’s aortic mural thrombus ratio and age can function as a pre-operative indicator of their underlying cardiac reserve. Identifying patients with low cardiac reserve and fitness to handle the increased cardiac demands due to the physiological response to extensive aortic stent grafting prior to undergoing aortic repair may allow for modification of pre-operative patient counseling and post-operative care guidelines to better treat this patient population.