Shah Tejas R, Rockman Caron B, Adelman Mark A, Maldonado Thomas S, Veith Frank J, Mussa Firas F
Division of Vascular and Endovascular Surgery, New York University School of Medicine, New York, NY, USA.
Vasc Endovascular Surg. 2014 Apr;48(3):230-3. doi: 10.1177/1538574413518122. Epub 2014 Jan 6.
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.
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.
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.
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.
对于急性单纯性B型主动脉夹层（TBAD），胸主动脉腔内修复术（TEVAR）仍存在争议。本研究旨在评估TEVAR对急性单纯性TBAD患者死亡率、发病率、住院时间（LOS）及出院状态的影响。
我们分析了2009年和2010年的全国住院患者样本。根据治疗类型对患者进行分类：TEVAR或药物治疗。比较治疗组之间的结局，包括死亡率、中风、心肌梗死（MI）、急性肾衰竭、出院处置和LOS。
我们确定了4706例TBAD患者。平均年龄为67岁，55%为男性。治疗选择包括504例行TEVAR和4202例行药物治疗。两组的总体校正住院死亡率相似（TEVAR组为8.5%，药物治疗组为10.3%，P = 0.224）。TEVAR发生中风的风险更高（优势比[OR]=1.61，95%置信区间[CI]=[1.14 - 2.27]；P = 0.0073）。TEVAR与住院时间延长相关（12天对5.6天，P < 0.0001），且患者出院回家的可能性较小（OR 0.73，95% CI 0.54 - 0.99；P = 0.013）。按年龄分层时，两组之间的所有结局相似，但TEVAR组的住院时间更长。
与药物治疗相比，急性单纯性TBAD的胸主动脉腔内修复术与相似的住院死亡率、MI和肾衰竭相关。TEVAR在70岁之前中风发生率更高且住院时间更长。由于将TEVAR应用于病情较轻的患者只会降低TEVAR的死亡率，这些发现支持更广泛地使用TEVAR治疗单纯性TBAD患者。
