Study Suggests TEVAR for Type B Aortic Dissections May Benefit Nonacute Patients

October 1, 2010—The Society for Vascular Surgery announced that investigators have released findings about the use and mortality rate of thoracic endovascular repair (TEVAR) of type B aortic dissections in the United States. Teviah Sachs, MD, et al published the study in the Journal of Vascular Surgery (2010;52:860–866).

Using data from the Nationwide Inpatient Sample database between 2005 and 2007, the investigators selected 10,466 patients who underwent either open repair or endovascular stent graft repair due to a diagnosis of thoracic aortic dissection or thoracoabdominal aortic dissection. Patients with an aortic aneurysm (n = 464) and those who had cardioplegia or were in need of operations on heart vessels or valves (n = 5,002) were presumed to have Type A dissections and were eliminated from the study.

“In-hospital mortality was 19% for open repair versus 10.6% for endovascular repair (odds ratio, 2.24; 95% confidence interval, 1.36–3.67; P < .01),” commented investigator Frank Pomposelli, MD. “The mortality rate was significantly higher, with open repair for patients 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).”

Complications were more frequent in the open repair group, including cardiac (12.4% vs 4.9%; P < .01), respiratory (7.7% vs 4.3%; P = .02), genitourinary (9% vs 2.5%; P < .01), hemorrhage (14% vs 2.8%; P < .01), and acute renal failure (32.1% vs 17.2%; P < .01). Median length of hospital stay was also greater in the open repair group compared to the TEVAR group (10.7 days vs 8.3 days; P < .01).

“Although we do not have data available in this retroactive cohort study regarding midterm or long-term durability of TEVAR in these patients, previous midterm follow-up studies for TEVAR in thoracic aortic aneurysms have shown that the greatest risk of death comes in the immediate perioperative period, which lends reliability to our findings,” noted Dr. Pomposelli.

Dr. Pomposelli added, “This study is valuable because it demonstrates that approximately 25% of repairs for type B aortic dissections are being performed by TEVAR. The endovascular approach is being used for older patients with greater comorbidities. Our study showed lower rates of complications and a reduction in mortality rates, cost, and length of hospital stay, which is very encouraging. The durability of TEVAR for anatomically suitable patients needing nonacute aortic repair remains an area of interest that is worthy of further study.”