Thoracic Endovascular Aortic Dissection May Benefit Non-Acute Patients
July 09, 2018
Researchers from Beth Israel Deaconess Medical Center (BIDMC) at Harvard Medical School in Boston have released findings about the use and mortality rate of thoracic endovascular repair type B aortic dissection (TBAD) in thoracic endovascular aortic repair (TEVAR) in the United States. This less-invasive dissection method is primarily used in non-acute aneurysm cases. Details of their research were published in the Society for Vascular Surgery's® October issue of the Journal of Vascular Surgery®.
Using data from the Nationwide Inpatient Sample database between 2005 and 2007, researchers selected 10,466 patients who underwent either open or endovascular stent graft repair for a diagnosis of thoracic aortic dissection or thoracoabdominal aortic dissection. Patients with an aortic aneurysm (464), and those who had cardioplegia or in need of operations on heart vessels or valves (5,002), presumed to be Type A (acute) dissections were eliminated from the study.
The remaining 5,000 patients made up the TBAD group. Of them, 3,965 patients had thoracic dissections (1,081 TEVAR and 2,884 open repair) and 1,035 had thoracoabdominal dissection (300 TEVAR and 735 open repair.)
"In-hospital mortality was 19 percent for open repair vs. 10.6 percent for endovascular repair," said Frank Pomposelli, MD, chief of Vascular and Endovascular Surgery at BIDMC and associate professor of surgery at Harvard Medical School. "The mortality rate was significantly higher with open repair for patients coded as emergent admissions (20.1 percent vs. 13.1 percent), but did not reach statistical significance for elective admissions (12.3 percent vs. 4.8 percent)."
Complications were more frequent in the open repair group, including cardiac (12.4 percent vs. 4.9 percent), respiratory (7.7 percent vs. 4.3 percent), genito-urinary (9.0 percent vs. 2.5 percent), hemorrhage (14.0 percent vs. 2.8 percent), and acute renal failure (32.1% vs. 17.2). Length of stay was also greater in the open repair group (Median length of stay: 10.7 days vs. 8.3 days).
"Although we do not have data available in this retroactive cohort study regarding midterm or long-term durability of TEVAR in these patients, previous mid-term follow-up studies for TEVAR in thoracic aortic aneurysms have shown that the greatest risk of death comes in the immediate perioperative period, which lends reliability to our findings," noted Dr. Pomposelli.
"This study is valuable because it demonstrates that approximately 25 percent of repairs for TBAD are being performed by TEVAR," added Dr. Pomposelli. "The endovascular approach is being used for older patients with greater comorbidities. Our study showed lower rates of complications and a reduction in mortality rates, cost and the length of hospital stay which is very encouraging. The durability of TEVAR for anatomically suitable patients needing non-acute aortic repair remains and area of interest that is worthy of further study."
Society for Vascular Surgery