Type B Thoracic Aortic Dissection: Open versus Endovascular Repair.

BACKGROUND: To assess morbidity and mortality in patients with Type B Thoracic Aortic Dissection who undergo operative repair.

METHODS: We queried the Nationwide Inpatient Sample (NIS) database, examining all records between 2005 and 2007. Using ICD-9 (International Classification of Diseases, 9th ed.) diagnosis codes, we selected patients who underwent either an open repair or an endovascular stent graft repair, for a diagnosis of Thoracic Aortic Dissection. We isolated only those patients undergoing repair for Type B Thoracic Aortic Dissection (TAD_B), by excluding patients with diagnosis codes for aortic aneurysm and procedure codes for cardioplegia or for operations on vessels of the heart or valves. We compared demographics and co-morbidities, as well as adjusted complications and mortality between the cohorts.

RESULTS: There were an estimated 8883 TAD_B repairs identified, with 7456 (84%) being performed Open and 1427 (16%) performed Endovascular (Table 1). Of these, 49 patients were converted from Endovascular to Open. Patients in the Endovascular group were older, with greater comorbidities, although only hypertension and peripheral vascular disease were statistically significant. In hospital mortality was 18.9% for Open Repair versus 10.1% for Endovascular repair (Table 2) with an odds ratio of 2.25 (95% CI (1.32, 3.81), p< 0.01). Cardiac complications (14% vs. 6 %, p< 0.01), Genito-Urinary complications (7% vs. 2%, p< 0.05) and Hemorrhage (14% vs. 3%, p< 0.01) were all more frequent in the open repair group. In hospital length of stay was also greater in the open repair group (Median: 10.05 days vs. 7.8 days, p< 0.01).

CONCLUSIONS: For patients with a diagnosis of TAD_B who undergo repair, Endovascular approach is being used for, on average, older patients with greater co-morbidities, yet has reduced morbidity and mortality.