Outcome comparison between thoracic endovascular and open repair for type B aortic dissection: A population-based longitudinal study

Hsiao-Ping Chou; Hsiao-Ting Chang; Chun-Ku Chen; Chun-Che Shih; Shih-Hsien Sung; Tzeng-Ji Chen; I-Ming Chen; Ming-Hsun Lee; Ming-Huei Sheu; Mei-Han Wu; Cheng-Yen Chang

doi:10.1016/j.jcma.2014.10.003

Outcome comparison between thoracic endovascular and open repair for type B aortic dissection: A population-based longitudinal study

J Chin Med Assoc. 2015 Apr;78(4):241-8. doi: 10.1016/j.jcma.2014.10.003. Epub 2015 Feb 7.

Authors

Affiliations

¹ Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
² Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Institute of Public Health and Community Medicine Research Center, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
³ Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Institute of Hospital and Health Care Administration, School of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Institute of Clinical Medicine, School of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC. Electronic address: ckchen@vghtpe.gov.tw.
⁴ Institute of Clinical Medicine, School of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
⁵ Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan, ROC.
⁶ Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Institute of Hospital and Health Care Administration, School of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
⁷ Department of Radiology, Lotung Poh-Ai Hospital, Yilan, Taiwan, ROC.
⁸ Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.

PMID: 25669134
DOI: 10.1016/j.jcma.2014.10.003

Abstract

Background: Management of diseases of the descending thoracic aorta is trending from open surgery toward thoracic endovascular aortic repair (TEVAR), because TEVAR is reportedly associated with less perioperative mortality. However, comparisons between TEVAR and open surgery, adjusting for patient comorbidities, have not been well studied. In this nationwide population-based study, we compared the outcomes between TEVAR and open surgery in type B aortic dissection.

Methods: From 2003 to 2009, data on patients with type B aortic dissection who underwent either open surgery or TEVAR were obtained from the National Health Insurance Research Database. Survival, length of stay, and complications were compared between TEVAR and open repair. To minimize possible bias, we performed an additional analysis after matching patients by age, sex, and propensity score.

Results: A total of 1661 patients were identified, of whom 1542 underwent open repair and 119 TEVAR. Patients in the TEVAR group were older (63.0 ± 15.4 years vs. 58.1 ± 13.1 years; p = 0.001), included more males, and had more preoperative comorbidities. Thirty-day mortality in the TEVAR group was significantly lower than that in the open repair group (4.2% vs. 17.8%; p < 0.001). The midterm survival rates in the unmatched cohort between the open surgery and TEVAR groups at 1 year, 2 years, 3 years, and 4 years were 76%, 73%, 71%, and 68% vs. 92%, 86%, 82%, and 79%, respectively. The length of stay in the TEVAR group was shorter than that in the open repair group (p = 0.001). The TEVAR group had less respiratory failure (p = 0.022) and fewer wound complications than the open repair group (p = 0.008). The matched cohort showed similar results.

Conclusion: TEVAR for type B aortic dissection repair has less perioperative mortality, a shorter length of hospitalization, a higher midterm survival rate, less postoperative respiratory failure, and fewer wound complications than open surgery.

Keywords: aneurysm; dissecting; endovascular procedures; postoperative period; propensity score.

Publication types

Comparative Study

MeSH terms

Adult
Aged
Aorta, Thoracic / surgery*
Aortic Aneurysm, Thoracic / mortality
Aortic Aneurysm, Thoracic / surgery*
Aortic Dissection / mortality
Aortic Dissection / surgery*
Cohort Studies
Endovascular Procedures / adverse effects
Endovascular Procedures / methods*
Female
Humans
Length of Stay
Longitudinal Studies
Male
Middle Aged