CardioExchange Archive

Long-term outcome after endovascular abdominal aortic aneurysm repair is no better than open repair or no repair (in patients deemed unsuitable for open repair), according to results of the EVAR 1 and EVAR 2 trials published online in the New England Journal of Medicine. Previous trials had found short-term benefits for endovascular repair, but the long-term effects were unknown.
   
In the EVAR 1 (United Kingdom Endovascular Aneurysm Repair 1) trial, 1,252 patients with large abdominal aortic aneurysms were randomized to endovascular or open repair. Despite early results in favor of the less invasive procedure, at 6 years there was no significant difference in mortality between the two groups, while costs were higher in the endovascular repair group.
   
In EVAR 2, 404 patients who were considered ineligible for open repair were randomized to either endovascular repair or no repair. There was no difference in long-term mortality between the two groups, although there was a significant reduction in aneurysm-related mortality in the endovascular repair group.

ICDs and CRTs in Older Patients: Although older patients were excluded from most of the large device trials, a nationally representative database finds that one-fifth of patients receiving ICD and CRT devices were 80 years of age or older. In a report in Archives of Internal Medicine, Swindle et al. found that age over 80 was an independent predictor of in-hospital mortality. The authors conclude that “given trends in the demographics of heart failure and the costs of device therapy, additional studies are required to clarify the appropriateness of device implantation in older patients with heart failure, as well as the merits of less invasive options.”