Arman Kilic1, Ashish S Shah1, James H Black1, Glenn J R Whitman1, David D Yuh2, Duke E Cameron1, John V Conte3. 1. Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, Md. 2. Section of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn. 3. Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, Md. Electronic address: jconte@jhmi.edu.
Abstract
BACKGROUND: To evaluate trends and outcomes of descending thoracic aortic aneurysm (DTAA) repair in the United States. METHODS: Adults undergoing DTAA repair between 1998 and 2008 were identified in the Nationwide Inpatient Sample. To limit confounding, patients with connective tissue disorders, aortic dissection, or thoracoabdominal aneurysms were excluded. Stratification was based on intact versus ruptured DTAA and open versus endovascular approach. Standardized annual rates of repair were calculated based on US Census Bureau population estimates. Logistic regression analysis incorporating multiple patient, operative, and hospital variables was used for risk adjustment. RESULTS: A total of 20,568 DTAA patients (intact, 17,780; ruptured, 2788) underwent repair (open, 15,265; endovascular, 5303). Patients undergoing repair in the more recent era had higher comorbidity burdens than those undergoing repair in the earlier era. Despite this, annual rates of repair for both intact and ruptured DTAAs increased significantly during the study period (intact, 2.2-10.6 per 1 million; ruptured, 0.8-1.3 per 1 million; P < .05), primarily because of increases in rates of endovascular repair in recent years. Operative mortality decreased from 10.3% to 3.1% for repairs of intact DTAAs (P < .001) and from 52.6% to 23.4% for ruptured DTAAs (P = .002). Endovascular repair was associated with reduced risk-adjusted mortality for both intact (odds ratio, 0.31; P < .001) and ruptured (odds ratio, 0.41; P = .001) DTAAs. CONCLUSIONS: Although patients undergoing DTAA repair in the modern era have a higher comorbidity burden, rates of repair have increased and operative mortality has decreased, in part because of the increasing adoption of endovascular approaches.
BACKGROUND: To evaluate trends and outcomes of descending thoracic aortic aneurysm (DTAA) repair in the United States. METHODS: Adults undergoing DTAA repair between 1998 and 2008 were identified in the Nationwide Inpatient Sample. To limit confounding, patients with connective tissue disorders, aortic dissection, or thoracoabdominal aneurysms were excluded. Stratification was based on intact versus ruptured DTAA and open versus endovascular approach. Standardized annual rates of repair were calculated based on US Census Bureau population estimates. Logistic regression analysis incorporating multiple patient, operative, and hospital variables was used for risk adjustment. RESULTS: A total of 20,568 DTAApatients (intact, 17,780; ruptured, 2788) underwent repair (open, 15,265; endovascular, 5303). Patients undergoing repair in the more recent era had higher comorbidity burdens than those undergoing repair in the earlier era. Despite this, annual rates of repair for both intact and ruptured DTAAs increased significantly during the study period (intact, 2.2-10.6 per 1 million; ruptured, 0.8-1.3 per 1 million; P < .05), primarily because of increases in rates of endovascular repair in recent years. Operative mortality decreased from 10.3% to 3.1% for repairs of intact DTAAs (P < .001) and from 52.6% to 23.4% for ruptured DTAAs (P = .002). Endovascular repair was associated with reduced risk-adjusted mortality for both intact (odds ratio, 0.31; P < .001) and ruptured (odds ratio, 0.41; P = .001) DTAAs. CONCLUSIONS: Although patients undergoing DTAA repair in the modern era have a higher comorbidity burden, rates of repair have increased and operative mortality has decreased, in part because of the increasing adoption of endovascular approaches.
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Authors: Isabel Jiménez-Trujillo; Montserrat González-Pascual; Rodrigo Jiménez-García; Valentín Hernández-Barrera; José M de Miguel-Yanes; Manuel Méndez-Bailón; Javier de Miguel-Diez; Miguel Ángel Salinero-Fort; Napoleón Perez-Farinos; Pilar Carrasco-Garrido; Ana López-de-Andrés Journal: Medicine (Baltimore) Date: 2016-05 Impact factor: 1.889