(PC024) Complex aortic repair may not offer survival benefit for frail patients: a survival analysis

Objectives: Clinical frailty is associated with reduced long-term survival for patients undergoing fenestrated and branched endovascular aortic repair (F/BEVAR). This study assesses the impact of phenotypic clinical frailty on perioperative outcomes and cause of death following F/BEVAR for patients with thoracoabdominal aortic aneurysm (TAAA).

Methods: Patients with TAAA who underwent F-BEVAR at a single institution from 2012 to 2024 were identified. The clinical frailty scale (CFS), a tool that categorizes patients from 1 (very fit) to 9 (terminally ill) based on physical fitness and vulnerability to health stressors, was used to determine phenotypic frailty. Patients with preoperative CFS >= 4 were considered frail. Univariate and multivariate analysis were used to compare perioperative outcomes and cause of death. Long-term survival was assessed with Kaplan-Meier and Cox regression analysis.

Results: A total of 234 patients were included; 61 (26.0%) had CFS >= 4 and 173 (74%) had CFS < 4. There were no differences in major perioperative adverse events, although patients with CFS >= 4 had an increased length of hospitalization (11.1±12.2 days vs. 6.9±6.9 days, p = 0.02) and were less likely to return to preoperative functional status (61.7% vs. 86.7%, p < 0.01) (Table I). Five-year all-cause and aortic-related mortality were 40.2% and 3.4%, respectively. Patients with CFS >= 4 had significantly reduced survival at 1-year (73% vs. 89%), 3-years (38% vs. 73%), and 5-years (25% vs. 56%), compared to patients with CFS < 4 (Figure I, p < 0.01). The most common causes of death among both groups were pulmonary comorbidities (13.9%), cancer/malignancy (13.9%), and procedure-related complications (12.0%). However, frail patients were more likely to die from aortic-related mortality (10.0% vs. 5.9%, p = 0.02), pulmonary comorbidities (15.0 vs. 13.2%, p = 0.04), systemic decline (7.5% vs. 1.5%, p = 0.02), and infection (12.5% vs. 7.5%, p = 0.03) (Table I).

Conclusions: High frailty patients have reduced long-term survival and increased aortic-related mortality following F/BEVAR. Increased frailty is also associated with prolonged hospitalization and a reduced likelihood of return to preoperative baseline. Phenotypic frailty assessment remains important for patient selection, risk stratification and preoperative counseling prior to F/BEVAR. Furthermore, these findings suggest that elective F/BEVAR may not provide meaningful survival benefit for clinically frail patients with TAAA.