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THE JOURNAL OF CARDIOVASCULAR SURGERY
Rivista di Chirurgia Cardiaca, Vascolare e Toracica
Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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The Journal of Cardiovascular Surgery 2014 Oct 17
Contemporary economic and clinical evaluations of endovascular repair for intact descending thoracic aortic aneurysms
Coppi G. 1, Chester J. 1, Gennai S. 1, Silingardi R. 1, Marcheselli L. 2, Brunetti M. 3 ✉
1 Department of Vascular Surgery, University of Modena and Reggio Emilia, Nuovo Ospedale S. Agostino Estense, Modena;
2 Department of Oncology and Hematology, University of Modena and Reggio Emilia;
3 Regional Sanitary Service for Emilia Romagna, Local Sanitary Unit, Modena
AIM: To assess clinical and contemporary costs associated with elective endovascular repair of intact descending thoracic aortic aneurysms into the mid term follow-up.
METHODS: A retrospective review of a prospectively maintained clinical database including 29 consecutive patients from July 2005 to December 2009 treated with elective endovascular repair (TEVAR) or TEVAR and surgical infrarenal repair (hybrid) of intact descending thoracic aortic aneurysms was performed. Mean age was 74.5 years old (± 7.1). Primary clinical endpoints include mortality and major morbidity. Additionally a comprehensive economic appraisal of individual in-hospital and follow up costs was executed. Economic endpoints include in-hospital and follow-up costs and patient discharge status. Elective endovascular and open repairs’ clinical and economical outcomes in contemporary literature were assessed for comparison according to PRISMA standards.
RESULTS: Immediate mortality was 6.9% (1/24 TEVAR and 1/5 hybrid). Three respiratory complications were recorded (11%; 2 TEVAR, 1 hybrid). Renal and cardiac complication rates were 7.4% (1 TEVAR, 1 hybrid) and 3.7% (1 TEVAR) respectively. Routine discharge home was achieved for 85% of patients (95.7% TEVAR, 25% hybrid). Three endoleaks were treated throughout the follow-up (2 TEVAR, 1 hybrid; mean 30.4 mo, ±19.9) rendering an 11% (3/27) reintervention rate. Average immediate cost was €21,976.87 for elective endovascular repair and €33,783.21 for elective endovascular hybrid repair. Additional reintervention and routine follow-up costs augmented immediate costs by 12.4%.
CONCLUSIONS: This study supports satisfying immediate clinical outcomes for TEVAR and TEVAR + surgical infrarenal procedures. Although limited by a small population size and difficulties in economic comparisons, this study presents the real world social and economic cost scenario for both elective TEVAR and TEVAR hybrid treatment of DTAA of both the in-hospital and at mid term follow-up periods.