Open and endovascular repair of type B aortic dissection in the Nationwide Inpatient Sample
Open and endovascular repair of type B aortic dissection in the Nationwide Inpatient Sample
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DOI：
10.1016/j.jvs.2010.05.008
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发表时间：
2010-10-01
影响因子：
4.3
通讯作者：
Schermerhorn, Marc
中科院分区：
文献类型：
--
作者：
Sachs, Teviah;Pomposelli, Frank;Schermerhorn, Marc
背景：B型胸主动脉夹层（T（B）AD）覆膜支架的使用和覆膜支架修复的死亡率尚未明确。我们试图确定国家估计的使用和死亡率的胸主动脉腔内修复术（TEVAR）T（B）ADintheUniteds.Methods：2005年和2007年之间的全国住院病人样本（NIS）数据库的记录进行了检查。使用国际疾病分类第9版（ICD-9）诊断代码选择接受开放性或TEVAR（带柄移植物）诊断胸主动脉夹层或胸腹主动脉夹层的患者。我们排除了诊断代码为主动脉瘤的患者和手术代码为心脏停搏液或心脏血管或瓣膜手术的患者，这些患者被认为是A型夹层（T（A）AD）。其余患者被认为是T（B）AD。我们比较了接受TEVAR与开放repair.Results的患者的人口统计学和合并症，以及调整后的并发症和死亡率：我们确定了估计10,466例胸主动脉或胸腹主动脉夹层修复（开放，8659; TEVAR，1818）。其中，464例诊断为主动脉瘤，5002例患者被认为是TA（A）D。在非囊性夹层中，5000例修复被认为是T（B）AD（开放，3619例; TEVAR，1381例）。血管内患者年龄较大，合并症较多，但只有心脏病、肾衰竭、高血压和外周血管疾病具有统计学显著性。开放修复术的住院死亡率为19%，TEVAR为10.6%（比值比[OR]，2.24; 95%置信区间[CI]，1.36-3.67; P <0.01）。急诊入院的开放性修复术的住院死亡率显著较高（20.1% vs 13.1%; P = 0.03），但择期入院的住院死亡率没有达到统计学显著性（12.3% vs 4.8%; P = 0.09）。心脏并发症（12.4%对4.9%，P < .01），呼吸系统并发症（7.7% vs 4.3%，P = 0.02），泌尿生殖系统并发症开放性修复组中，出血（9.0% vs 2.5%，P <0.01）和急性肾功能衰竭（32.1% vs 17.2%，P <0.01）更常见。开放修复组的中位住院时间更长（10.7 vs 8.3天，P <0.01）。结论：对于诊断为T（B）AD并接受修复的患者，血管内方法用于合并症较多的老年患者，但降低了发病率和住院死亡率。腔内覆膜支架修复术治疗B型胸主动脉夹层值得进一步纵向分析。（J Vase Surg 2010;52：860-6.）
Background: The use of stent grafts and mortality of stent graft repair of type B thoracic aortic dissection (T(B)AD) is not well defined. We sought to determine national estimates for the use and mortality of thoracic endovascular aortic repair (TEVAR) for T(B)AD in the United States.Methods: Records of the Nationwide Inpatient Sample (NIS) database between 2005 and 2007 were examined. International Classification of Diseases, 9th edition (ICD-9) diagnosis codes were used to select patients who underwent open or TEVAR with a stem graft for a diagnosis of thoracic aortic dissection or thoracoabdominal aortic dissection. We excluded patients with a diagnosis code for aortic aneurysm and those with procedure codes for cardioplegia or for operations on heart vessels or valves, which were considered type A dissections (T(A)AD). The remaining patients were considered as T(B)AD. We compared demographics and comorbidities, as well as adjusted complications and mortality rates, between patients undergoing TEVAR vs open repair.Results: We identified an estimated 10,466 repairs for dissection of the thoracic or thoracoabdominal aorta (open, 8659; TEVAR, 1818). Of these, 464 had a diagnosis of aortic aneurysm, and 5002 patients were considered TA(A)D. Of nonaneurysmal dissections, 5000 repairs were considered T(B)AD (open, 3619; TEVAR, 1381). The endovascular patients were older and had greater comorbidities, although only cardiac disease, renal failure, hypertension, and peripheral vascular disease were statistically significant. In-hospital mortality was 19% for open repair vs 10.6% for TEVAR (odds ratio [OR], 2.24; 95% confidence interval [CI], 1.36-3.67; P < .01). In-hospital mortality was significantly higher with open repairs coded as emergent admissions (20.1% vs 13.1%; P = .03), but did not reach statistical significance for elective admissions (12.3% vs 4.8%; P = .09). Cardiac complications (12.4% vs 4.9%, P < .01), respiratory complications (7.7% vs 4.3%, P = .02), genitourinary complications (9.0% vs 2.5%, P < .01), hemorrhage (14.0% vs 2.8%, P < .01), and acute renal failure (32.1% vs 17.2%, P < .01) were more frequent in the open repair group. Median length of stay was greater in the open repair group (10.7 vs 8.3 days, P < .01).Conclusion:For patients with a diagnosis of T(B)AD who undergo repair, the endovascular approach is being used for older patients with greater comorbidities, yet has reduced morbidity and in-hospital mortality. The use of endovascular stent graft repair for type B thoracic aortic dissection merits further longitudinal analysis. (J Vase Surg 2010;52:860-6.)