D. Craig Miller, MD The Journal of Thoracic and Cardiovascular Surgery

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Through the looking glass: The first 20 years of thoracic aortic stent-grafting D. Craig Miller, MD The Journal of Thoracic and Cardiovascular Surgery Volume 145, Issue 3, Pages S142-S148 (March 2013) DOI: 10.1016/j.jtcvs.2012.11.076 Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Five-year midterm survival for the initial 103 patients treated with TEVAR at Stanford between 1992 and 1997. (A) Actuarial survival estimates for all patients compared with an age- and gender-matched US population. (B) Survival estimates subdivided according to whether the patient was judged to be a reasonable open surgical candidate. Error bars = ± 1 standard error. Reprinted with permission from: Demers P, Miller DC, Mitchell RS, Kee ST, Sze D, Razavi MK, et al. Midterm results of endovascular repair of descending thoracic aortic aneurysms with first-generation stent grafts. J Thorac Cardiovasc Surg. 2004;127:664-73. The Journal of Thoracic and Cardiovascular Surgery 2013 145, S142-S148DOI: (10.1016/j.jtcvs.2012.11.076) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 (A) Annual rate of total (diamonds), open surgical (squares), and endovascular (TEVAR, triangles) repair for descending and thoracoabdominal aneurysm in the US. Medicare patients between 1998 and 2007. (B) Regional variation in use of open and endovascular repair (TEVAR) of thoracic and thoracoabdominal aneurysms among Medicare beneficiaries in 2007. CI, Confidence interval. Reprinted with permission from: Scali ST, Goodney PP, Walsh DB, Travis LL, Nolan BW, Goodman DC, et al. National trends and regional variation of open and endovascular repair of thoracic and thoracoabdominal aneurysms in contemporary practice. J Vasc Surg. 2011;53:1499-505. The Journal of Thoracic and Cardiovascular Surgery 2013 145, S142-S148DOI: (10.1016/j.jtcvs.2012.11.076) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Meta-analyses of mortalities for thoracic endovascular aortic repair (TEVAR) versus open surgery. The odds ratio for death from each included study is plotted. A pooled estimate of overall odds ratio (diamonds) and 95% confidence intervals (CI, width of diamonds) summarizes the effect size with the random effects model. Effects to the left of 1.0 favor thoracic endovascular aortic repair; effects to the right favor open surgery. When the horizontal bars of an individual study, or the pooled diamond width, cross 1.0, the effect is not significantly different. The I2 for heterogeneity was not significant, suggesting homogeneity in effect size across each study. Reprinted with permission from: Cheng D, Martin J, Shennib H, Dunning J, Muneretto C, Schueler S, et al. Endovascular aortic repair versus open surgical repair for descending thoracic aortic disease a systematic review and meta-analysis of comparative studies. J Am Coll Cardiol. 2010;55:986-1001. A, Meta-analysis comparing death at 1 year for thoracic endovascular aortic repair versus open surgery. B, Meta-analysis comparing death at 2 to 3 years for thoracic endovascular aortic repair versus open surgery. The Journal of Thoracic and Cardiovascular Surgery 2013 145, S142-S148DOI: (10.1016/j.jtcvs.2012.11.076) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Risk-stratified Kaplan-Meier estimates (K-M Est) of survival. CI, Confidence interval; L/M/H, low/middle/high. Reprinted with permission from: Lee WA, Daniels MJ, Beaver TM, Klodell CT, Raghinaru DE, Hess PJ Jr. Late outcomes of a single-center experience of 400 consecutive thoracic endovascular aortic repairs. Circulation. 2011;123:2938-45. The Journal of Thoracic and Cardiovascular Surgery 2013 145, S142-S148DOI: (10.1016/j.jtcvs.2012.11.076) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Unadjusted 5-year survivals for patients with thoracic aneurysms by procedure type and diagnosis. TEVAR, Thoracic endovascular aortic repair. Reprinted with permission from: Goodney PP, Travis L, Lucas FL, Fillinger MF, Goodman DC, Cronenwett JL, et al. Survival after open versus endovascular thoracic aortic aneurysm repair in an observational study of the Medicare population. Circulation. 2011;124:2661-9. A, Survival after thoracic aneurysm repairs. B, Survival after thoracic aneurysm repairs performed after 2002; adjusted analyses representing male, nonblack patients younger than 76 years with Charlson score less than 2. C, Propensity-matched survivals after thoracic aneurysm repair. The Journal of Thoracic and Cardiovascular Surgery 2013 145, S142-S148DOI: (10.1016/j.jtcvs.2012.11.076) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions