Impact of operative indication and surgical complexity on outcomes after thoracic endovascular aortic repair at National Surgical Quality Improvement Program Centers

Ehlert, Bryan A.; Durham, Christopher A.; Parker, Frank M.; Bogey, William M.; Powell, Charles S.; Stoner, Michael C.

doi:10.1016/j.jvs.2011.05.116

Cited by 32 publications

(21 citation statements)

References 39 publications

(38 reference statements)

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“…All groups studied exhibited higher adverse outcome rates when treated in the nonelective setting, which is intuitive and has been reported previously. 20 The overall rate of neurological complications (stroke and spinal cord injury) in patients with nonelective TAA in the present study appears similar to that described elsewhere and is clearly a source of major morbidity in this group of patients, [21][22][23][24] although not in the patients with acute or chronic dissection. There is no proven explanation for the lower incidence of spinal cord injury in patients with type B aortic dissection, although the lower incidence of comorbidities and continued perfusion of the false lumen after TEVAR may play a role.…”

Section: Discussionsupporting

confidence: 88%

Aortic Pathology Determines Midterm Outcome After Endovascular Repair of the Thoracic Aorta

et al. 2013

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Given the spectrum of different pathologies that affect the descending thoracic aorta, it is important to define whether the outcome of TEVAR is pathology specific to refine procedural technique and endograft design. Careful analysis of long-term Background-Endovascular repair of the thoracic aorta has become an increasingly utilized therapy. Although the shortterm mortality advantage over open surgery is well documented, late mortality and the impact of presenting pathology on long-term outcomes remain poorly reported. Methods and Results-A database was built from 5 prospective studies and a single institutional series. Rates of perioperative adverse events were calculated, as were midterm death and reintervention rates. Multivariate analysis was performed with the use of logistic regression modeling. Kaplan-Meier survival curves were drawn for midterm outcomes. The database contained 1010 patients: 670 patients with thoracic aortic aneurysm, 195 with chronic type B aortic dissection, and 114 with acute type B aortic dissection. Lower elective mortality was observed in patients with chronic dissections (3%) compared with patients with aneurysms (5%). Multivariate analysis identified age, mode of admission, American Society of Anesthesiologists grade, and pathology as independent predictors of 30-day death (P < 0.05). In the midterm, the all-cause mortality rate was 8, 4.9, and 3.2 deaths per 100 patient-years for thoracic aortic aneurysm, acute type B aortic dissection, and chronic type B aortic dissection, respectively. The rates of aortic-related death were 0.6, 1.2, and 0.4 deaths per 100 patient-years for thoracic aortic aneurysm, acute type B aortic dissection, and chronic type B aortic dissection, respectively. Conclusions-This study indicated that the midterm outcomes of endovascular repair of the thoracic aorta are defined by presenting pathology, associated comorbidities, and mode of admission. Nonaortic mortality is high in the midterm for patients with thoracic aortic aneurysm, and managing modifiable risk factors appears vital. Endovascular repair of the thoracic aorta results in excellent midterm protection from aortic-related mortality, regardless of presenting pathology. (Circulation. 2013;127:24-32.)

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Section: Discussionsupporting

confidence: 88%

Aortic Pathology Determines Midterm Outcome After Endovascular Repair of the Thoracic Aorta

et al. 2013

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“…The most serious complications of TEVAR are neurologic resulting from ischemia or embolization. Perioperative acute ischemic stroke associated with TEVAR has a reported incidence of 3.5% to 5.5% (22,23) and is more common if the TEVAR involves more proximal aorta (landing zones 0-2) (24). Excessive wire and catheter manipulation in a diseased aortic arch with risks of air embolism from deployment systems and inadvertent coverage of arch branches, increases the risk of stroke.…”

Section: Discussionmentioning

confidence: 99%

Thoracic endovascular repair for acute type A aortic dissection: operative technique

Shah

Khoynezhad

2016

Ann. Cardiothorac. Surg.

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“…We utilized a NSQIP version of the CCI to stratify patients' 10-year risk of mortality [17]. Previous studies have verified that the CCI adapted to large administrative databases has similar sensitivity in stratifying mortality [18], and this strategy has been used in NSQIP in previous studies [19,20].…”

Section: Methodsmentioning

confidence: 99%

Acuity, outcomes, and trends in the transfer of surgical patients: a national study

et al. 2015

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Patients transferred for surgery represent a higher acuity population than non-transferred patients, and the number of transfers continues to rise. Even when matched by comorbidities, transferred patients have worse outcomes. Surgical sub-specialization and physician tiering may complicate future transfer practices. Efficient transfers, effective physician communication, and ready availability of medical records are critical in improving patient transfers.

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Impact of operative indication and surgical complexity on outcomes after thoracic endovascular aortic repair at National Surgical Quality Improvement Program Centers

Cited by 32 publications

References 39 publications

Aortic Pathology Determines Midterm Outcome After Endovascular Repair of the Thoracic Aorta

Aortic Pathology Determines Midterm Outcome After Endovascular Repair of the Thoracic Aorta

Thoracic endovascular repair for acute type A aortic dissection: operative technique

Acuity, outcomes, and trends in the transfer of surgical patients: a national study

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