Journal of cardiothoracic surgery · 2026
Anatomy-driven strategies and mid-term outcomes of branched endovascular repair of the aortic arch: a single-center cohort study.
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Zhao Bin, Liu Zongwei, Liang Hao, Bi Jiaxue, Dai Xiangchen
Аннотация
BACKGROUND: Thoracic endovascular aortic repair (TEVAR) with branch reconstruction is an alternative to open surgery for aortic arch pathologies. However, mid-term data comparing different strategies are limited. This study aimed to evaluate the mid-term outcomes of single- and double-branch TEVAR and analyze the performance of different single-branch reconstruction techniques.
METHODS: We retrospectively analyzed 198 consecutive patients who underwent TEVAR for aortic arch lesions with either single-branch (n = 169) or double-branch (n = 29) reconstruction at a single center between February 2015 and December 2023. The primary endpoint was the mid-term all-cause mortality. The secondary endpoints included technical success, perioperative safety, aorta-related complications, and reintervention rates. Kaplan-Meier survival analysis, multivariable Cox regression, and Restricted Mean Survival Time (RMST) analysis were performed. The influence of age was explored using Restricted Cubic Splines (RCS), modeling age continuously.
RESULTS: The overall technical success rate was 96.0%. The mean follow-up duration was 40.5 months. There was no significant difference in mid-term all-cause mortality between the single- and double-branch groups (Log-rank P = 0.710). Multivariable Cox regression identified older age as an independent predictor of mortality (HR 1.047 per year, 95% CI 1.012-1.084, P = 0.009) but not the number of branches reconstructed (P = 0.611). Among the single-branch techniques, RMST analysis confirmed no significant difference in mid-term survival (all pairwise P > 0.050). An inverse association between age and aorta-related complications was suggested (OR 0.957, 95% CI 0.923-0.993, P = 0.020), which most plausibly reflects selection bias and warrants confirmation in larger, multicenter studies.
CONCLUSION: In this single-center cohort study, single- and double-branch TEVAR yielded no statistically significant difference in mid-term survival. Age, and not the number of reconstructed branches, was the primary predictor of mortality. All single-branch techniques showed comparable mid-term survival, supporting an individualized, anatomy-driven approach. The observed inverse association between age and aorta-related complications highlights the critical role of patient selection in these complex procedures and warrants confirmation in larger, multicenter studies with standardized anatomical assessment and imaging follow-up.
METHODS: We retrospectively analyzed 198 consecutive patients who underwent TEVAR for aortic arch lesions with either single-branch (n = 169) or double-branch (n = 29) reconstruction at a single center between February 2015 and December 2023. The primary endpoint was the mid-term all-cause mortality. The secondary endpoints included technical success, perioperative safety, aorta-related complications, and reintervention rates. Kaplan-Meier survival analysis, multivariable Cox regression, and Restricted Mean Survival Time (RMST) analysis were performed. The influence of age was explored using Restricted Cubic Splines (RCS), modeling age continuously.
RESULTS: The overall technical success rate was 96.0%. The mean follow-up duration was 40.5 months. There was no significant difference in mid-term all-cause mortality between the single- and double-branch groups (Log-rank P = 0.710). Multivariable Cox regression identified older age as an independent predictor of mortality (HR 1.047 per year, 95% CI 1.012-1.084, P = 0.009) but not the number of branches reconstructed (P = 0.611). Among the single-branch techniques, RMST analysis confirmed no significant difference in mid-term survival (all pairwise P > 0.050). An inverse association between age and aorta-related complications was suggested (OR 0.957, 95% CI 0.923-0.993, P = 0.020), which most plausibly reflects selection bias and warrants confirmation in larger, multicenter studies.
CONCLUSION: In this single-center cohort study, single- and double-branch TEVAR yielded no statistically significant difference in mid-term survival. Age, and not the number of reconstructed branches, was the primary predictor of mortality. All single-branch techniques showed comparable mid-term survival, supporting an individualized, anatomy-driven approach. The observed inverse association between age and aorta-related complications highlights the critical role of patient selection in these complex procedures and warrants confirmation in larger, multicenter studies with standardized anatomical assessment and imaging follow-up.