Contemporary Surgical Management of Aortic Dissection at National Surgical Quality Improvement Program Centers

Abstract

Objective: Thoracic Endovascular Aortic Repair (TEVAR) is being performed for aortic dissection at many centers; however, its real-world outcomes as well as the risk factors associated with adverse events remain poorly defined. We aim to define risk factors associated with 30day mortality following TEVAR for dissection, compared to traditional open surgical repair (OSR). Methods: National Surgical Quality Improvement Program (NSQIP) data was analyzed from 2007 to 2012. Mortality after TEVAR and OSR for aortic dissection was compared and associated risk factors identified. Results: During the study period, a total of 495 TEVAR and 118 OSR were performed. Patients in the OSR group were younger, less likely to have pre-existing anemia, renal insufficiency, andemergent operations (table1). Therewasnodifference in the 30-day mortality rates between OSR (10.2%) and TEVAR (8.5%) groups (P1⁄40.56). The OSR group had higher rates of wound complications, respiratory failure, transfusion requirements, and unplanned re-operation (table 1). Onmultivariable analysis, age>50, history of CHF, paraplegia, prior operation in last 30 days, emergent surgery, unplanned reintubation, and septic shock were independently associated with increased 30-day mortality. (table 2). Conclusion: Overall 30-day mortality was not significantly different between the two surgical techniques. However, older patients with more medical comorbidities underwent TEVAR. Age >50, history of CHF, operation in the previous 30 days, emergency surgery, unplanned re-intubation, and septic shock were independent predictors of 30-day mortality.