Systematic Review and Meta-Analysis to Assess Safety and Early Mortality in Octogenarians undergoing Fenestrated and Branched Endovascular Aortic Repair for Complex Aortic Aneurysms.

Objectives: The population in the U.S., and across the world is aging rapidly which warrants an assessment of the safety of surgical approaches in elderly individuals to better risk stratify and inform surgeons' decision making for optimal patient care. This review is designed to assess the risk of 30-day mortality and other outcomes of interest among the octogenarians undergoing fenestrated or branched endovascular aortic aneurysm repair (F/BEVAR) for thoracoabdominal aortic aneurysms (TAAAs).

Methods: The review protocol was registered in the PROSPERO database (CRD42023435673). A systematic review of the English literature was performed using literature databases PubMed and Scopus from inception till May 2024. The review was designed on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and included only studies reporting 30-day mortality following F/BEVAR. The risk of bias was evaluated utilizing the Risk of Bias in Non-randomized Studies - of Interventions (ROBINS-I) tool. A pooled odds ratio (OR) for the overall mortality was computed, and a p-value of <0.05 was designated as statistically significant. Interstudy heterogeneity was evaluated by Q-metric and quantified using Higgins I statistics.

Results: Nine studies were found fit for the meta-analysis per inclusion and exclusion criteria. Of these seven studies, three exclusively reported F/BEVAR for Type IV TAAA. Based on a random effects model, a 30-day mortality for octogenarians undergoing F/BEVAR for any type of TAAA was found to be higher (OR, 1.73; 95% CI, 1.13-2.63, p=0.250), however was not statistically difference as compared to non-octogenarians. This insignificance was pertinent, when a meta-analysis with similar model was computed for Type IV TAAA (OR, 1.89; 95% CI, 0.75-4.77, p= 0.163). Other outcomes including spinal cord ischemia, kidney injury, transient ischemic attack or stroke, non-home discharge, and all-cause reintervention were all found not to be statistically significant in the older population.

Conclusions: No statistical difference was observed for the risk of 30-day mortality in octogenarians versus non-octogenarians undergoing F/BEVAR for TAAA. This finding was consistent in sub-group meta-analysis of F/BEVAR for Type IV TAAAs, and all other outcomes. Factors pertaining to patient's health, and the system factors like surgeon's skills and postoperative care should be weighed when performing F/BEVAR in older patients. Further research is imperative to assess and better understand the impact of comorbidities on surgical outcomes.