Outcome comparison between thoracic endovascular and open repair for type B aortic dissection: A population-based longitudinal study

Hsiao Ping Chou, Hsiao Ting Chang, Chun Ku Chen, Chun Che Shih, Shih Hsien Sung, Tzeng Ji Chen, I. Ming Chen, Ming Hsun Lee, Ming Huei Sheu, Mei Han Wu, Cheng Yen Chang

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Abstract

Background: Management of diseases of the descending thoracic aorta is trending from open surgery toward thoracic endovascular aortic repair (TEVAR), because TEVAR is reportedly associated with less perioperative mortality. However, comparisons between TEVAR and open surgery, adjusting for patient comorbidities, have not been well studied. In this nationwide population-based study, we compared the outcomes between TEVAR and open surgery in type B aortic dissection. Methods: From 2003 to 2009, data on patients with type B aortic dissection who underwent either open surgery or TEVAR were obtained from the National Health Insurance Research Database. Survival, length of stay, and complications were compared between TEVAR and open repair. To minimize possible bias, we performed an additional analysis after matching patients by age, sex, and propensity score. Results: A total of 1661 patients were identified, of whom 1542 underwent open repair and 119 TEVAR. Patients in the TEVAR group were older (63.0±15.4 years vs. 58.1±13.1 years; p=0.001), included more males, and had more preoperative comorbidities. Thirty-day mortality in the TEVAR group was significantly lower than that in the open repair group (4.2% vs. 17.8%; p<0.001). The midterm survival rates in the unmatched cohort between the open surgery and TEVAR groups at 1 year, 2 years, 3 years, and 4 years were 76%, 73%, 71%, and 68% vs. 92%, 86%, 82%, and 79%, respectively. The length of stay in the TEVAR group was shorter than that in the open repair group (p=0.001). The TEVAR group had less respiratory failure (p=0.022) and fewer wound complications than the open repair group (p=0.008). The matched cohort showed similar results. Conclusion: TEVAR for type B aortic dissection repair has less perioperative mortality, a shorter length of hospitalization, a higher midterm survival rate, less postoperative respiratory failure, and fewer wound complications than open surgery.

Original languageEnglish
Pages (from-to)241-248
Number of pages8
JournalJournal of the Chinese Medical Association
Volume78
Issue number4
DOIs
Publication statusPublished - Apr 1 2015
Externally publishedYes

Fingerprint

Longitudinal Studies
Dissection
Thorax
Population
Thoracic Surgery
Thoracic Aorta
Respiratory Insufficiency
Mortality
Comorbidity
Length of Stay
Survival Rate
Propensity Score
Wounds and Injuries
National Health Programs
Disease Management
Hospitalization
Databases
Survival
Research

Keywords

  • Aneurysm
  • Dissecting
  • Endovascular procedures
  • Postoperative period
  • Propensity score

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Outcome comparison between thoracic endovascular and open repair for type B aortic dissection : A population-based longitudinal study. / Chou, Hsiao Ping; Chang, Hsiao Ting; Chen, Chun Ku; Shih, Chun Che; Sung, Shih Hsien; Chen, Tzeng Ji; Chen, I. Ming; Lee, Ming Hsun; Sheu, Ming Huei; Wu, Mei Han; Chang, Cheng Yen.

In: Journal of the Chinese Medical Association, Vol. 78, No. 4, 01.04.2015, p. 241-248.

Research output: Contribution to journalArticle

Chou, Hsiao Ping ; Chang, Hsiao Ting ; Chen, Chun Ku ; Shih, Chun Che ; Sung, Shih Hsien ; Chen, Tzeng Ji ; Chen, I. Ming ; Lee, Ming Hsun ; Sheu, Ming Huei ; Wu, Mei Han ; Chang, Cheng Yen. / Outcome comparison between thoracic endovascular and open repair for type B aortic dissection : A population-based longitudinal study. In: Journal of the Chinese Medical Association. 2015 ; Vol. 78, No. 4. pp. 241-248.
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T1 - Outcome comparison between thoracic endovascular and open repair for type B aortic dissection

T2 - A population-based longitudinal study

AU - Chou, Hsiao Ping

AU - Chang, Hsiao Ting

AU - Chen, Chun Ku

AU - Shih, Chun Che

AU - Sung, Shih Hsien

AU - Chen, Tzeng Ji

AU - Chen, I. Ming

AU - Lee, Ming Hsun

AU - Sheu, Ming Huei

AU - Wu, Mei Han

AU - Chang, Cheng Yen

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N2 - Background: Management of diseases of the descending thoracic aorta is trending from open surgery toward thoracic endovascular aortic repair (TEVAR), because TEVAR is reportedly associated with less perioperative mortality. However, comparisons between TEVAR and open surgery, adjusting for patient comorbidities, have not been well studied. In this nationwide population-based study, we compared the outcomes between TEVAR and open surgery in type B aortic dissection. Methods: From 2003 to 2009, data on patients with type B aortic dissection who underwent either open surgery or TEVAR were obtained from the National Health Insurance Research Database. Survival, length of stay, and complications were compared between TEVAR and open repair. To minimize possible bias, we performed an additional analysis after matching patients by age, sex, and propensity score. Results: A total of 1661 patients were identified, of whom 1542 underwent open repair and 119 TEVAR. Patients in the TEVAR group were older (63.0±15.4 years vs. 58.1±13.1 years; p=0.001), included more males, and had more preoperative comorbidities. Thirty-day mortality in the TEVAR group was significantly lower than that in the open repair group (4.2% vs. 17.8%; p<0.001). The midterm survival rates in the unmatched cohort between the open surgery and TEVAR groups at 1 year, 2 years, 3 years, and 4 years were 76%, 73%, 71%, and 68% vs. 92%, 86%, 82%, and 79%, respectively. The length of stay in the TEVAR group was shorter than that in the open repair group (p=0.001). The TEVAR group had less respiratory failure (p=0.022) and fewer wound complications than the open repair group (p=0.008). The matched cohort showed similar results. Conclusion: TEVAR for type B aortic dissection repair has less perioperative mortality, a shorter length of hospitalization, a higher midterm survival rate, less postoperative respiratory failure, and fewer wound complications than open surgery.

AB - Background: Management of diseases of the descending thoracic aorta is trending from open surgery toward thoracic endovascular aortic repair (TEVAR), because TEVAR is reportedly associated with less perioperative mortality. However, comparisons between TEVAR and open surgery, adjusting for patient comorbidities, have not been well studied. In this nationwide population-based study, we compared the outcomes between TEVAR and open surgery in type B aortic dissection. Methods: From 2003 to 2009, data on patients with type B aortic dissection who underwent either open surgery or TEVAR were obtained from the National Health Insurance Research Database. Survival, length of stay, and complications were compared between TEVAR and open repair. To minimize possible bias, we performed an additional analysis after matching patients by age, sex, and propensity score. Results: A total of 1661 patients were identified, of whom 1542 underwent open repair and 119 TEVAR. Patients in the TEVAR group were older (63.0±15.4 years vs. 58.1±13.1 years; p=0.001), included more males, and had more preoperative comorbidities. Thirty-day mortality in the TEVAR group was significantly lower than that in the open repair group (4.2% vs. 17.8%; p<0.001). The midterm survival rates in the unmatched cohort between the open surgery and TEVAR groups at 1 year, 2 years, 3 years, and 4 years were 76%, 73%, 71%, and 68% vs. 92%, 86%, 82%, and 79%, respectively. The length of stay in the TEVAR group was shorter than that in the open repair group (p=0.001). The TEVAR group had less respiratory failure (p=0.022) and fewer wound complications than the open repair group (p=0.008). The matched cohort showed similar results. Conclusion: TEVAR for type B aortic dissection repair has less perioperative mortality, a shorter length of hospitalization, a higher midterm survival rate, less postoperative respiratory failure, and fewer wound complications than open surgery.

KW - Aneurysm

KW - Dissecting

KW - Endovascular procedures

KW - Postoperative period

KW - Propensity score

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