title: Outcome comparison between thoracic endovascular and open repair for type B aortic dissection: A population-based longitudinal study.
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.
  
  
  CONCLUSIONS
  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.
authors: Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
authors: Hsiao-Ping
authors: HP
authors: Chou
authors: Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Institute of Public Health and Community Medicine Research Center, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
authors: Hsiao-Ting
authors: HT
authors: Chang
authors: Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Institute of Hospital and Health Care Administration, School of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Institute of Clinical Medicine, School of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC. Electronic address: ckchen@vghtpe.gov.tw.
authors: Chun-Ku
authors: CK
authors: Chen
authors: Institute of Clinical Medicine, School of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
authors: Chun-Che
authors: CC
authors: Shih
authors: Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan, ROC.
authors: Shih-Hsien
authors: SH
authors: Sung
authors: Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Institute of Hospital and Health Care Administration, School of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
authors: Tzeng-Ji
authors: TJ
authors: Chen
authors: Institute of Clinical Medicine, School of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
authors: I-Ming
authors: IM
authors: Chen
authors: Department of Radiology, Lotung Poh-Ai Hospital, Yilan, Taiwan, ROC.
authors: Ming-Hsun
authors: MH
authors: Lee
authors: Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
authors: Ming-Huei
authors: MH
authors: Sheu
authors: Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
authors: Mei-Han
authors: MH
authors: Wu
authors: Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
authors: Cheng-Yen
authors: CY
authors: Chang
mesh_terms: D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000601:surgery*; D015331:Cohort Studies; D057510:Endovascular Procedures / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged
keywords: aneurysm; dissecting; endovascular procedures; postoperative period; propensity score