Endovascular (TEVAR) Versus Open Surgical Repair For The Management Of Unruptured Thoracic Aortic Aneurysms In Patients With Marfan's Syndrome

INTRODUCTION AND OBJECTIVES Treatment of thoracic aortic aneurysms (TAA) in patients with Marfan's syndrome has classically involved open repair; however, emerging data suggest similar efficacy between endovascular (TEVAR) approaches and conventional surgery. As there are limited data regarding this population, we compare 5-year morbidity and mortality rates after TEVAR versus open repair for unruptured TAA in Marfan's patients. METHODS Study timeframe was 1 January, 2010-31 December 2020. We used the TriNetX database to identify patients with Marfan's syndrome who had undergone TEVAR, as well as a propensity score-matched cohort of patients who had undergone open repair for first instance unruptured TAA. We compared postoperative mortality, reintervention, and complication rates using Kaplan-Meier estimates and Cox models over a 5-year follow up period. RESULTS Before matching, outcomes of 58 TEVAR patients were compared with 297 open repair patients. At 5 years, total reintervention rate, reintervention via endovascular technique, and paraplegia were more common in the TEVAR group. After matching for age, sex, and past cardiovascular surgery, only total reintervention rate and endovascular reintervention remained higher in the TEVAR group; Tables 1 and 2. Incidence of mortality, aortic dissection, limb ischemia, and renal failure was similar between groups. CONCLUSIONS Complications were common in patients undergoing TEVAR and open repair. Although reintervention via endovascular technique was more frequent in patients treated initially with TEVAR, incidence of mortality and other adverse outcomes were similar between groups. As endovascular approaches advance, further research is needed to better elucidate the role of TEVAR in treating TAAs in patients with Marfan's syndrome.