Nationwide Comparative Impact of Thoracic Endovascular Aortic Repair of Acute Uncomplicated Type B Aortic Dissections
| Autor: | Tejas R. Shah, Firas F. Mussa, Thomas S. Maldonado, Frank J. Veith, Mark A. Adelman, Caron B. Rockman |
|---|---|
| Rok vydání: | 2014 |
| Předmět: |
Male
medicine.medical_specialty Time Factors Aortic repair Risk Assessment Blood Vessel Prosthesis Implantation Postoperative Complications Risk Factors Odds Ratio Humans Medicine In patient Hospital Mortality Myocardial infarction Stroke Aged Retrospective Studies Aortic Aneurysm Thoracic business.industry Patient Selection Endovascular Procedures Discharge disposition General Medicine Odds ratio Length of Stay medicine.disease Patient Discharge United States Confidence interval Surgery Aortic Dissection Dissection Treatment Outcome Acute Disease Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | Vascular and Endovascular Surgery. 48:230-233 |
| ISSN: | 1938-9116 1538-5744 |
| DOI: | 10.1177/1538574413518122 |
| Popis: | Objective: Thoracic endovascular aortic repair (TEVAR) for acute uncomplicated type B aortic dissection (TBAD) remains controversial. This study aims to evaluate the impact of TEVAR on mortality, morbidity, length of stay (LOS), and discharge status in patients with acute uncomplicated TBAD. Methods: We analyzed the National Inpatient Sample from 2009 and 2010. Patients were categorized according to the type of treatment: TEVAR or medical management. Outcomes, including mortality, stroke, myocardial infarction (MI), acute renal failure, discharge disposition, and LOS, were compared between the treatment groups. Results: We identified 4706 patients with TBAD. Mean age was 67 years and 55% were male. Treatment options included TEVAR in 504 and medical management in 4202. The overall adjusted in-hospital mortality was similar for both the groups (8.5% for TEVAR vs 10.3% for medical management, P = .224). The TEVAR carried higher risk of stroke (odds ratio [OR] = 1.61, 95% confidence interval [CI] = [1.14-2.27]; P = .0073). The TEVAR was associated with prolonged LOS (12 vs 5.6 days, P < .0001) and patients were less likely to be discharged home (OR 0.73, 95% CI 0.54-0.99; P = .013). When stratified by age, all outcomes were similar between the 2 groups, with the exception of longer LOS with TEVAR. Conclusions: Thoracic endovascular aortic repair for acute uncomplicated TBAD was associated with similar in-hospital mortality, MI, and renal failure as compared to medical management. The TEVAR had higher rate of stroke up to the age 70 years and longer LOS. Because extending TEVAR to less complicated patients could only decrease TEVAR mortality rates, these findings support the more widespread use of TEVAR to treat patients with uncomplicated TBAD. |
| Databáze: | OpenAIRE |
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