Impact of hybrid thoracic endovascular aortic repair for aortic arch diseases on life expectancy

This study aimed to investigate whether the efficacy of proximal landing zones (LZs) 0, 1, and 2 in hybrid thoracic endovascular aortic repair (TEVAR) without cardiopulmonary bypass (CPB) in elderly patients can broaden aortic arch surgical eligibility from the perspective of a lifetime loss. From April 2008 to March 2020, 254 patients who underwent LZs 0, 1, and 2 hybrid TEVAR without CPB were enrolled (zone 0 in 41, zone 1 in 82, and zone 2 in 131 patients). The patients had a median age of 73 years, with a median follow-up period of 5.8 years. The median operative time was 172 min, the median postoperative hospital stay was 11 days, and the discharge rate to home was 95.3%. The survival rate, aorta-related death-free rate, and aortic events-free rate at 10 years were 72.8%, 97.0%, and 88.5%. A multivariable Cox proportional hazard regression analysis showed that age (p < 0.001), preoperative stroke (p = 0.042), and an occurrence of 30-day aortic events (p = 0.022) were significant risk factors for all-cause death. The lifetime loss for 75, 80, 85, and >= 90-year-old patients at the time of surgery was 0.2, 0.1, 0, and 0 years. Despite the high risk of surgical management of aortic arch diseases, this study revealed that LZs 0, 1, and 2 hybrid TEVAR without CPB in >= 75-year-old patients can be expected to result in a life expectancy similar to the standard life expectancy. Advanced age alone should not exclude surgical treatment for patients with arch diseases.