COLUMBIA, Mo. — A minimally invasive procedure used to repair thoracic aortic aneurysms produced better outcomes for older patients than traditional open-incision surgery, according to research conducted by a cardiothoracic surgeon at University Hospital.
Raja Gopaldas, M.D., a cardiothoracic surgeon at University Hospital, presented the research findings at the annual meeting of the American Association for Thoracic Surgery recently.
Gopaldas also reported that the minimally invasive procedure could benefit patients in rural areas, because most small hospitals have endovascular or cardiac catheterization labs where the minimally invasive surgery could be performed.
The thoracic aorta is a section of the aorta, the largest artery in the body, which carries oxygenated blood away from the heart to all parts of the body. An aneurysm, the abnormal widening or ballooning of a part of the artery caused by a weakness in the blood vessel wall, can cause severe internal bleeding and even death if it ruptures.
Aneurysms of this kind are fairly rare in younger patients. But with older patients, especially those with additional health issues, there are higher risks for complications with open-incision surgery, along with longer hospital stays and longer recovery time.
“Being able to offer these patients a minimally invasive alternative that they can tolerate better allows us as surgeons to improve outcomes,” said Gopaldas.
The findings were the result of analysis of data collected from the Nationwide Inpatient Sample, through the Agency for Healthcare Research and Quality. This annual sampling included surgery patients between the years 2006 to 2008 from more than 1,000 U.S. hospitals. Gopaldas and his colleagues compiled the data to show the difference between the traditional open-incision procedure and the relatively new minimally invasive procedure for repairing thoracic aortic aneurysms.
“Thoracic endovascular aneurysm repair, or TEVAR, is a minimally invasive procedure that utilizes a catheter inserted through an incision in the groin,” said Gopaldas. “We use this catheter to thread a stent device into the weakened area of the aorta that has bulged or has ruptured. The device is then deployed in the aneurysm so that it closes off the rupture if a tear is present, provides stability for the vessel where the aneurysm is and maintains an open portal for blood to flow through.”
The study found that use of the TEVAR procedure in emergency thoracic aneurysm repair at small hospitals resulted in an almost 80 percent reduction in complications.
However, Gopaldas points out that the TEVAR procedure is not for everyone.
“In younger patients who are in their 30s and 40s, where the case is not an emergent one, it’s better to use the traditional open-incision method,” said Gopaldas. “The reason for this is that follow-up for the minimally invasive procedure dictates that we do a yearly CT scan to verify that the stent device is not leaking, and that exposes younger patients, over the duration of their lives, to more radiation than we consider acceptable. And because they are young, they tolerate the open-incision procedure very well.”
“Our research indicates this fairly new technology has certain specific advantages in some cases, particularly those involving older patients at smaller hospitals,” said Gopaldas. “But in larger hospitals with dedicated open-heart surgical teams there may not be as much of a difference, because they are equally proficient in performing both open and TEVAR techniques.”