Propensity Score-Matched Analysis of Open Surgical and Endovascular Repair for Type B Aortic Dissection

Natalia N. Egorova,Alan J. Moskowitz,Michael E. Brunt

doi:10.1155/2011/364046

Natalia N. Egorova, Alan J. Moskowitz + Show 1 more

Open Access

https://doi.org/10.1155/2011/364046

Copy DOI

Abstract

Objective. To identify national outcomes of thoracic endovascular aortic repair (TEVAR) for type B aortic dissections (TBADs). Methods. The Nationwide Inpatient Sample database was examined from 2005 to 2008 using ICD-9 codes to identify patients with TBAD who underwent TEVAR or open surgical repair. We constructed separate propensity models for emergently and electively admitted patients and calculated mortality and complication rates for propensity score-matched cohorts of TEVAR and open repair patients. Results. In-hospital mortality was significantly higher following open repair than TEVAR (17.5% versus 10.8%, P = .045) in emergently admitted TBAD. There was no in-hospital mortality difference between open repair and TEVAR (5.6% versus 3.3%, P = .464) for elective admissions. Hospitals performing thirty or more TEVAR procedures annually had lower mortality for emergent TBAD than hospitals with fewer than thirty procedures. Conclusions. TEVAR produces better in-hospital outcomes in emergent TBAD than open repair, but further longitudinal analysis is required.

Highlights

Aortic dissection is a rare condition, with annual incidence of three to eight cases/100,000 people [1,2,3], which is associated with high morbidity and mortality
In the absence of such complications, which is the case for seventy percent of patients with acute type B dissection [6], medical therapy with antihypertensives has been the standard of care
The possibility that thoracic endovascular aortic repair (TEVAR) can facilitate better remodeling of the aorta than medical therapy and avert late aortic rupture has stimulated its use in treating uncomplicated type B aortic dissections (TBADs) patients, who traditionally would have received medical therapy alone [8, 9]

Summary

Introduction

Aortic dissection is a rare condition, with annual incidence of three to eight cases/100,000 people [1,2,3], which is associated with high morbidity and mortality. Acute type B dissections that are complicated by visceral or limb ischemia, aortic rupture, refractory pain, or rapidly expanding dissection require surgical intervention [5]. In the absence of such complications, which is the case for seventy percent of patients with acute type B dissection [6], medical therapy with antihypertensives has been the standard of care. The possibility that TEVAR can facilitate better remodeling of the aorta than medical therapy and avert late aortic rupture has stimulated its use in treating uncomplicated TBAD patients, who traditionally would have received medical therapy alone [8, 9]

Methods

Results

Discussion

Conclusion