Brunt Michael E, Egorova Natalia N, Moskowitz Alan J
Department of Health Evidence and Policy, Mount Sinai School of Medicine, One Gustave L. Levy Place, P.O. Box 1077, New York, NY 10029, USA.
Int J Vasc Med. 2011;2011:364046. doi: 10.1155/2011/364046. Epub 2011 Sep 27.
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.
目的。确定B型主动脉夹层（TBAD）的胸主动脉腔内修复术（TEVAR）的全国性治疗结果。方法。利用国际疾病分类第九版（ICD-9）编码，对2005年至2008年的全国住院患者样本数据库进行检查，以识别接受TEVAR或开放手术修复的TBAD患者。我们为急诊和择期入院患者构建了单独的倾向模型，并计算了TEVAR和开放修复患者倾向评分匹配队列的死亡率和并发症发生率。结果。在急诊入院的TBAD中，开放修复后的院内死亡率显著高于TEVAR（17.5%对10.8%，P = 0.045）。对于择期入院患者，开放修复和TEVAR之间的院内死亡率没有差异（5.6%对3.3%，P = 0.464）。每年进行30例或更多TEVAR手术的医院，急诊TBAD的死亡率低于手术例数少于30例的医院。结论。在急诊TBAD中，TEVAR比开放修复产生更好的院内治疗结果，但需要进一步的纵向分析。
