Comparison of mid-term outcomes of endovascular repair and medical management in patients with acute uncomplicated type B aortic dissection
Comparison of mid-term outcomes of endovascular repair and medical management in patients with acute uncomplicated type B aortic dissection
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DOI：
10.1016/j.jtcvs.2019.11.127
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发表时间：
2021-06-12
影响因子：
6
通讯作者：
Zheng, Chuansheng
中科院分区：
文献类型：
--
作者：
Xiang, Dongqiao;Kan, Xuefeng;Zheng, Chuansheng
目的：为了进一步评估胸主动脉腔内修复术（TEVAR）治疗急性无并发症B型主动脉夹层（TBAD）患者与接受最佳药物治疗（BMT）患者的早期和中期结局，方法：回顾性分析了2008年2月至2018年3月期间357例急性无并发症TBAD患者。其中191例接受TEVAR，166例接受BMT。倾向评分匹配后，我们获得了145个匹配对进行了分析。结果：在匹配人群中，TEVAR组和BMT组之间的30天死亡率无统计学显著差异，而TEVAR组的早期不良事件发生率显著高于BMT组（P = 0.003）。TEVAR组的无全因死亡率显著高于BMT组（TEVAR：5年时91.9%，BMT：5年时82.2%，P = 0.028）。TEVAR组的无肿瘤相关死亡率显著高于BMT组（TEVAR：5年时为94.1%，BMT：5年时为86.1%，P = 0.044）。多变量Cox风险回归分析表明，年龄较大（风险比[HR]，1.04; 95%置信区间[CI]，1.01-1.08，P = 0.013）、BMT（HR，2.33; 95% CI，1.08-5.05，P = 0.032）和主入口撕裂与左锁骨下动脉之间的距离
Objectives: To further assess the early and mid-term outcomes of thoracic endovascular aortic repair (TEVAR) in patients with acute uncomplicated type B aortic dissection (TBAD) compared with those receiving best medical treatment (BMT).Methods: Between February 2008 and March 2018, 357 consecutive patients with acute uncomplicated TBAD were retrospectively analyzed. Among them, 191 patients underwent TEVAR, and 166 received BMT. After propensity score matching, we obtained 145 matched pairs for analysis.Results: In the matched population, the 30-day mortality between the TEVAR group and the BMT group showed no statistically significant difference, whereas the early adverse events rates in the TEVAR group were significantly greater than that of the BMT group (P = .003). Freedom from all-cause mortality in the TEVAR group was significantly greater than that of the BMT group (TEVAR: 91.9% at 5 years, BMT: 82.2% at 5 years, P = .028). Freedom from aortic-related mortality in the TEVAR group was significantly greater than that of the BMT group (TEVAR: 94.1% at 5 years, BMT: 86.1% at 5 years, P = .044). Multivariable Cox-hazard regression analysis demonstrated that the older age (hazard ratio [HR], 1.04; 95% confidence interval [CI], 1.01-1.08, P = .013), BMT (HR, 2.33; 95% CI, 1.08-5.05, P = .032), and the distance between the primary entry tear and the left subclavian artery