Association of Thoracic Aortic Aneurysm Versus Aortic Dissection on Outcomes After Thoracic Endovascular Aortic Repair
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 Result...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-03-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.122.027641 |
| _version_ | 1827214914365685760 |
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| author | Irsa S. Hasan James A. Brown Derek Serna‐Gallegos Edgar Aranda‐Michel Sarah Yousef Yisi Wang Ibrahim Sultan |
| author_facet | Irsa S. Hasan James A. Brown Derek Serna‐Gallegos Edgar Aranda‐Michel Sarah Yousef Yisi Wang Ibrahim Sultan |
| author_sort | Irsa S. Hasan |
| collection | DOAJ |
| description | 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], P<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, P<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, P<0.001). On multivariable adjustment, TBAD was independently associated with mortality (odds ratio, 2.06 [95% CI, 1.68–2.52]; P<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. |
| first_indexed | 2024-04-09T23:22:59Z |
| format | Article |
| id | doaj.art-6d209420b32e48c48c95ae298520c82f |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2025-03-21T14:38:54Z |
| publishDate | 2023-03-01 |
| publisher | Wiley |
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| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-6d209420b32e48c48c95ae298520c82f2024-06-22T04:39:10ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802023-03-0112610.1161/JAHA.122.027641Association of Thoracic Aortic Aneurysm Versus Aortic Dissection on Outcomes After Thoracic Endovascular Aortic RepairIrsa S. Hasan0James A. Brown1Derek Serna‐Gallegos2Edgar Aranda‐Michel3Sarah Yousef4Yisi Wang5Ibrahim Sultan6Division of Cardiac Surgery, Department of Cardiothoracic Surgery University of Pittsburgh PA USADivision of Cardiac Surgery, Department of Cardiothoracic Surgery University of Pittsburgh PA USADivision of Cardiac Surgery, Department of Cardiothoracic Surgery University of Pittsburgh PA USADivision of Cardiac Surgery, Department of Cardiothoracic Surgery University of Pittsburgh PA USADivision of Cardiac Surgery, Department of Cardiothoracic Surgery University of Pittsburgh PA USAHeart and Vascular Institute University of Pittsburgh Medical Center PA USADivision of Cardiac Surgery, Department of Cardiothoracic Surgery University of Pittsburgh PA USABackground 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], P<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, P<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, P<0.001). On multivariable adjustment, TBAD was independently associated with mortality (odds ratio, 2.06 [95% CI, 1.68–2.52]; P<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.https://www.ahajournals.org/doi/10.1161/JAHA.122.027641aortic aneurysmaortic dissectionclinical outcomesreadmissionthoracic endovascular aortic repair |
| spellingShingle | Irsa S. Hasan James A. Brown Derek Serna‐Gallegos Edgar Aranda‐Michel Sarah Yousef Yisi Wang Ibrahim Sultan Association of Thoracic Aortic Aneurysm Versus Aortic Dissection on Outcomes After Thoracic Endovascular Aortic Repair Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease aortic aneurysm aortic dissection clinical outcomes readmission thoracic endovascular aortic repair |
| title | Association of Thoracic Aortic Aneurysm Versus Aortic Dissection on Outcomes After Thoracic Endovascular Aortic Repair |
| title_full | Association of Thoracic Aortic Aneurysm Versus Aortic Dissection on Outcomes After Thoracic Endovascular Aortic Repair |
| title_fullStr | Association of Thoracic Aortic Aneurysm Versus Aortic Dissection on Outcomes After Thoracic Endovascular Aortic Repair |
| title_full_unstemmed | Association of Thoracic Aortic Aneurysm Versus Aortic Dissection on Outcomes After Thoracic Endovascular Aortic Repair |
| title_short | Association of Thoracic Aortic Aneurysm Versus Aortic Dissection on Outcomes After Thoracic Endovascular Aortic Repair |
| title_sort | association of thoracic aortic aneurysm versus aortic dissection on outcomes after thoracic endovascular aortic repair |
| topic | aortic aneurysm aortic dissection clinical outcomes readmission thoracic endovascular aortic repair |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.122.027641 |
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