O-155 - THE EFFECT OF SEVERITY OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE, FRAILTY AND SARCOPENIA ON PATIENT SURVIVAL AFTER FENESTRATED-BRANCHED ENDOVASCULAR AORTIC REPAIR OF COMPLEX AORTIC ANEURYSMS

TOPIC:
Thoraco-abdominal Aortic Disease
AUTHORS:
Wong J. (University of Texas Health Science Center at Houston ~ Houston ~ United States of America) , Dias-Neto M. (University of Texas Health Science Center at Houston ~ Houston ~ United States of America) , Barbosa Lima G. (University of Texas Health Science Center at Houston ~ Houston ~ United States of America) , Ramos Tenorio E. (University of Texas Health Science Center at Houston ~ Houston ~ United States of America) , Baghbani-Oskouei A. (University of Texas Health Science Center at Houston ~ Houston ~ United States of America) , Saqib N. (University of Texas Health Science Center at Houston ~ Houston ~ United States of America) , Mendes B. (Mayo Clinic ~ Rochester ~ United States of America) , Mirza A. (University of Texas Health Science Center at Houston ~ Houston ~ United States of America) , Oderich G. (University of Texas Health Science Center at Houston ~ Houston ~ United States of America)
Introduction:
To assess the effect of chronic pulmonary obstructive disease (COPD) severity, frailty and sarcopenia on patient survival after fenestrated-branched endovascular aortic (FB-EVAR) repair of complex abdominal (CAAA) and thoracoabdominal aortic aneurysms (TAAA).
Methods:
The clinical data and outcomes of consecutive patients enrolled in a prospective non-randomized study to investigate FB-EVAR for treatment of CAAAs and TAAAs was reviewed (2013-2021). COPD severity was classified using Global Initiative for COPD as GOLD classes 1-2 (mild to moderate) or 3-4 (moderate to severe). Sarcopenia was assessed using lean psoas muscle area (LPMA) based on analysis of computed tomography imaging and frailty using the 5-factor modified frailty index (mFI) scores. Primary end-point was patient survival. Secondary end-points were 30-day or in-hospital mortality and major adverse events (MAE), discharge home, freedom from aneurysm-related mortality, freedom from secondary intervention and freedom from aneurysm sac enlargement.
Results:
There were 466 patients (70% male; mean 74±8 years-old) enrolled in the study. Aneurysm extent was CAAAs in 138 (29%), Extent IV TAAA in 141 (31%) and Extent I-III TAAA in 187 (40%). Of these, 136 patients (28%) had COPD, which was classified as GOLD 1-2 in 63% and GOLD 3-4 in 37%. Patients with COPD had significantly (P<.05) higher proportion of male sex (73% vs 58%), prior smoking history (96% v 80%), coronary artery disease (54% vs 44%), congestive heart failure (CHF) (16% vs 5%), peripheral artery disease (97% vs 34%), and has significant lower LPMA (231 [171] vs 279 [192] cm2HU) and higher mFI scores (2.1±0.7 vs 1.1±0.6), corresponding to increased frailty. There was no difference in technical success among patients with COPD, except for more frequent utilization of Iliofemoral conduits among COPD patients (15% vs 6%, P=.002). Mortality at 30-days was similar in patients with or without COPD, independent of severity (Table I). At 90-days, mortality was significantly higher among patients with GOLD 1-2 or GOLD 3-4 compared to those without COPD (7.9% vs 8.5% vs 1.2%, P<.001). However, patient survival at 1-, 3- and 5-years was similar among patients without COPD or with GOLD 1-2 COPD, but was significantly lower among those with GOLD 3-4 COPD (Figure 1, P=.003). Independent predictors of patient survival by multivariate analysis were body mass index (BMI) (adjusted Hazard Ration [aHR] .945, 95% Confidence Interval [CI] .903-.989; P=.015), congestive heart failure (aHR 2.06, 95%CI 1.13-3.76; P=.018), LPMA <350cm2HU (aHR 1.95; 95%CI 1.11-3.42; P=.019) and COPD GOLD 3-4 (aHR 1.90; 95%CI 1.11-3.23; P=.019). There were no differences in freedom from aneurysm-related mortality, freedom from reintervention and freedom from aneurysm-sac enlargement among patients with COPD GOLD 1-2, GOLD 3-4 and no COPD at 5-years.
Conclusion:
FB-EVAR was performed with low 30-day or in-hospital mortality and rate of MAEs among patients with or without COPD, independent of their severity level. Despite a higher mortality at 90-days among patient with COPD, there was no difference in survival for patients with mild to moderate COPD and those without COPD. Independent predictors of survival were low BMI, CHF, severe sarcopenia and moderate-severe COPD. Severity of COPD had no impact on aneurysm-related mortality, secondary interventions and aneurysm sac changes.
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