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| Superior Nationwide Outcomes of Thoracic Endovascular Aneurysm Repair (TEVAR) Compared to Open Repair for Isolated Descending Thoracic Aneurysm in a Cohort of 11,000 Patients | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Raja R. Gopaldas1, Joseph Huh1, Tam K. Dao1, Scott A. LeMaire1, Danny Chu1, Faisal G. Bakaeen1, Joseph Coselli1; 1 Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX; 2 Texas Heart Institute, St. Luke's Episcopal Hospital, Houston, TX; 3 Department of Education Psychology, University of Houston, Houston, TX; 4 Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX Objective: Thoracic endovascular aneurysm repair (TEVAR) was introduced for the treatment of descending thoracic aortic aneurysm (DTAA) in 2005. Little is known about TEVAR’s nationwide impact on patient outcomes. We evaluated the nationwide estimates of short-term outcomes of TEVAR and open DTAA procedures performed in the US during a 2-year period. Methods: From the weighted Nationwide Inpatient Sample databases, we identified patients who underwent surgery for isolated DTAA in 2006-2007. Patients with vasculitis, connective tissue disorders, or concomitant aneurysms in other aortic segments were excluded. Of the remaining 11,669 patients, 9106 underwent conventional open aortic repair (OAR) and 2563 underwent TEVAR. Hierarchic logistic and multivariable regression were used to assess the effect of TEVAR vs. OAR after adjusting for potential confounding factors. Primary outcomes were mortality and length of stay (LOS); secondary outcomes were disposition, morbidity, and hospital charges. Results: Patients who underwent TEVAR were older (69.5±12.7 y vs 60.2±14.2 y; P<0.001) and had higher Charlson-Deyo comorbidity scores (4.6±1.8 vs 3.3±1.8; P<0.001). Unadjusted LOS was shorter for TEVAR patients (7.7±11 d vs 8.8±7.9 d), but unadjusted mortality was similar (TEVAR 2.3%, n= 59; vs OAR 2.3%, n= 209; P=1.0). The proportion of non-elective interventions was similar between groups (TEVAR 15.9%, n= 405; vs OAR 15.8%, n=1446; P=0.9). After risk adjustment, TEVAR and OAR produced similar mortality rates, but TEVAR patients had a lower overall complication rate and a shorter LOS (by 1.3 days); however, hospital charges were higher by $6713/patient (95% CI $1869-$11,556; P<0.001). TEVAR patients were 4 times more likely to have a routine discharge to home, and they had fewer intra-operative, neurologic, and respiratory complications, but no differences in the incidence of pulmonary embolism (P=0.5). Overall, TEVAR was associated with a 60% lower risk of any complication than OAR (OR = 0.39; P< 0.001). Conclusion: The nationwide data on TEVAR for DTAA associate this procedure with better short-term outcomes than OAR, even though TEVAR is selectively performed in patients who are almost a decade older than OAR patients. TEVAR is associated with a shorter hospital LOS and 1 fewer complication for every 3 patients, but significantly higher. hospital charges Future studies should assess the long-term success of TEVAR vs the gold standard OAR. Effect of TEVAR on outcomes after DTAA repair
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Copyright © 2012 American Association for Thoracic Surgery
All rights reserved. IMPORTANT REMINDER: The preceding information is intended only to provide
general guidance and not as a definitive basis for diagnosis or treatment in any particular case.
It is very important that you consult a doctor about any specific medical problem or question.
All rights reserved. IMPORTANT REMINDER: The preceding information is intended only to provide
general guidance and not as a definitive basis for diagnosis or treatment in any particular case.
It is very important that you consult a doctor about any specific medical problem or question.