Advanced Age Linked to Poorer TEVAR Outcomes Despite Similar Aortic Remodeling, finds study

A new study published in the journal of BMC Surgery found that advanced age was associated with increased postoperative mortality and neurological complications following thoracic endovascular aortic repair (TEVAR), although overall complication rates and aortic remodeling outcomes remain similar across age groups.

Type B aortic dissection (TBAD) and descending thoracic aortic aneurysms (DTAA) are uncommon but deadly heart diseases. In particular, until they die, the majority of DTAA patients seem to be asymptomatic. Because TEVAR, which includes DTAA and TBAD, is less invasive than traditional open surgery, it has been used extensively to treat thoracic aortic pathology over the past 20 years. It is unclear if getting older increases the chance of having a bad outcome from TEVAR. Thus, this study assessed the relationship between advanced age and post-TEVAR outcomes.

In July 2023, a systematic search of the PubMed and Web of Science databases was conducted to find studies pertaining to TEVAR and age. The odds ratio (OR) or hazard ratio (HR) were used to evaluate the relationships between advanced age and TEVAR outcomes for people with any kind of thoracic aortic disease. This study also compared the ages of patients who experienced adverse events following TEVAR. The Newcastle-Ottawa Scale was used to evaluate the quality of the study.

This meta-analysis included a total of 70 studies with 52,605 patients. Every study that was enrolled was regarded as being of high quality. In general, advanced age was substantially linked to increased risk of neurological complications (p = 0.006), particularly delirium (p = 0.009), spinal cord ischemia (p = 0.02), and overall neurological complications (p = 0.007), as well as postoperative mortality (p < 0.0001).

Interestingly, postoperative stroke patients were marginally older than non-stroke patients (p = 0.05). Nevertheless, there was no significant correlation between advanced age and a higher risk of postoperative overall complications (p = 0.59) or adverse aortic remodeling events (p = 0.34), such as false lumen dilatation (p = 0.52) or aortic dilatation (p = 0.43). Furthermore, the age difference between patients who suffered acute kidney damage following TEVAR and those who did not was statistically significant (p = 0.04).

Overall, while overall complications and aortic remodeling outcomes are similar, poor TEVAR outcomes, such as postoperative mortality and neurological complications, are linked to advanced age. Younger patients also had an even higher incidence of AKI. Before choosing to perform TEVAR on elderly patients, it is crucial to weigh the risks and benefits. For elderly patients, optimal peri-operative care should be created and offered.

Reference:

Li, J., Zou, P., Zhou, Y., Wang, J., Zhang, Y., Tan, X., Liu, M., & Hu, M. (2025). Advanced age is significantly associated with poor outcomes of thoracic endovascular aortic repair: a systematic review and meta-analysis. BMC Surgery, 25(1), 289. https://doi.org/10.1186/s12893-025-02990-x