Division of Cardiac Surgery, Department of Cardiothoracic Surgery University of Pittsburgh PA USA.
Heart and Vascular Institute University of Pittsburgh Medical Center PA USA.
J Am Heart Assoc. 2023 Mar 21;12(6):e027641. doi: 10.1161/JAHA.122.027641. Epub 2023 Mar 9.
Background Because thoracic endovascular aortic repair (TEVAR) has become the standard of care for complicated type B aortic dissection (TBAD) and descending thoracic aortic (DTA) aneurysm, it is important to understand outcomes and use of TEVAR across thoracic aortic pathologies. Methods and Results This was an observational study of patients with TBAD or DTA undergoing TEVAR from 2010 to 2018, using the Nationwide Readmissions Database. In-hospital mortality, postoperative complications, admission costs, and 30- and 90-day readmissions were compared between the groups. Mixed model logistic regression was used to identify variables associated with mortality. An estimated total of 12 824 patients underwent TEVAR nationally, of which 6043 had an indication of TBAD and 6781 of DTA. Patients with aneurysms were more likely to be older, women, have cardiovascular disease, and have chronic pulmonary disease compared with patients with TBAD. Weighted in-hospital mortality was higher for TBAD (8% [1054/12 711] versus 3% [433/14 407], <0.001), compared with DTA, as were all postoperative complications. Patients with TBAD had a higher cost of care during their index admission (57.3 versus 38.8 × $1000, <0.001), compared with DTA. The 30-day and 90-day weighted readmissions were more frequent for the TBAD group compared with DTA (20% [1867/12 711] and 30% [2924/12 711] versus 15% [1603/14 407] and 25% [2695/14 407], respectively, <0.001). On multivariable adjustment, TBAD was independently associated with mortality (odds ratio, 2.06 [95% CI, 1.68-2.52]; <0.001). Conclusions After TEVAR, patients who presented with TBAD had higher rates of postoperative complications, in-hospital mortality, and cost compared with DTA. The incidence of early readmission was substantial for patients undergoing TEVAR, faring worse for those undergoing TEVAR for TBAD as compared with DTA.
由于胸主动脉腔内修复术（TEVAR）已成为复杂型 B 型主动脉夹层（TBAD）和降主动脉（DTA）动脉瘤的标准治疗方法，因此了解胸主动脉病变中 TEVAR 的结果和应用非常重要。
这是一项使用全国再入院数据库对 2010 年至 2018 年期间接受 TEVAR 治疗的 TBAD 或 DTA 患者进行的观察性研究。比较了两组患者的院内死亡率、术后并发症、入院费用以及 30 天和 90 天的再入院率。采用混合模型逻辑回归分析确定与死亡率相关的变量。据估计，全国共有 12824 例患者接受了 TEVAR 治疗，其中 6043 例有 TBAD 指征，6781 例有 DTA。与 TBAD 患者相比，动脉瘤患者年龄更大、女性更多、患有心血管疾病和慢性肺部疾病。TBAD（8%[1054/12711]）与 DTA（3%[433/14407]）相比，TBAD 的院内死亡率更高（均<0.001），所有术后并发症的发生率也更高。TBAD 患者的住院费用也更高（57.3 比 38.8×1000 美元，均<0.001）。与 DTA 相比，TBAD 组的 30 天和 90 天加权再入院率更高（20%[1867/12711]和 30%[2924/12711]与 15%[1603/14407]和 25%[2695/14407]，均<0.001）。多变量调整后，TBAD 与死亡率独立相关（比值比，2.06[95%置信区间，1.68-2.52]；<0.001）。
TEVAR 后，TBAD 患者的术后并发症、院内死亡率和费用均高于 DTA。TEVAR 患者的早期再入院率相当高，与 DTA 相比，TBAD 患者的再入院率更差。
