Ten-Year Clinical Characteristics and Early Outcomes of Type B Aortic Dissection Patients With Thoracic Endovascular Aortic Repair

Abstract

Objective/Background: This study examined the 10-year hospitalization characteristics, economic patterns and early clinical outcomes of type B aortic dissection (TBAD) patients that underwent thoracic endovascular aortic repair (TEVAR) in one high-volume hospital in China. Methods: We performed a population-based retrospective analysis based on electronic medical record system data provided by Zhongshan Hospital Fudan University from 2009 to 2018. Results: We identified 1,367 cases of TBAD patients with TEVAR over the past decade. The total incidence of in-hospital complications was 7.6% (104 of 1,367), among which acute kidney injury (AKI) had the highest incidence (3.1%, 42 of 1,367). Aortic-related reintervention was performed in 7 patients (0.5%). The overall aortic-related in-hospital mortality rate was 2.7% (37 of 1,367) and had no significant time-varying trend ( P = 0.2). Among these, 27% of in-hospital deaths were caused by retrograde type A dissection (RTAD). Chronic TBAD had a higher risk of in-hospital death versus acute TBAD, with a risk ratio of 2.69 (95% confidence interval [CI]: 1.19-6.09). Patients with hypertension (risk ratio 4.63, 95% CI: 1.38, 15.54) also had a higher in-hospital death risk. These 2 factors were also the predictive factors for the composite endpoint of in-hospital adverse events (risk ratio 2.17, 95% CI: 1.43, 3.29 and risk ratio 4.83, 95% CI: 1.90, 12.28, respectively), in addition to Marfan syndrome (risk ratio 4.05, 95% CI: 1.61, 10.19). The average length of hospitalization significantly declined during the past decade (annual percentage change -6.3%, 95% CI -8.2 to -4.3), and the stent-grafts (SGs) cost was the main expenditure of the total hospitalization costs. Conclusion: Our study showed a favorable early outcome of TEVAR over the past decade. Greater attention should be paid to certain risk factors in order to reduce the in-hospital adverse events. SG expenditure is still the primary economic burden on Chinese TBAD patients.

Association of genetic variants in ULK4 with the age of first onset of type B aortic dissection

“…Most patients in our TBAD cohort were male, most had hypertension, and few of them had diabetes. These population characteristics are consistent with the reported TBAD in the Chinese population (Huang et al, 2021). Based on whole genome sequencing data, we demonstrated that the ULK4 gene is associated with the age of TBAD onset based on both the SKAT and 2-sample MR analyses.…”

Trends in the incidence, surgical management and outcomes of type B aortic dissections in Australia over the last decade

“…[8][9][10] This is further affected by the majority of observational cohort studies originating from high volume, specialized centres with results that may not always be generalizable. 13,17 The present analyses of a comprehensive national dataset, as well as population-based data, reflects comprehensive and generalizable outcomes. The authors have identified relatively low operative mortality following intervention for TBAD in the setting of increasing admissions and procedure rates.…”

“…This trend appears to be consistent with other studies. 17 The reasons for the observed advances are unclear, but may include better and prompter medical management, enhanced surgical case selection and timing of intervention, as well as improving stent technology and increasing technical expertise. Not surprisingly, several post-intervention complications were more common following OAR compared to TEVAR.…”