期刊
ANNALS OF SURGERY
卷 276, 期 5, 页码 E598-E604出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/SLA.0000000000004561
关键词
aortic dissection; TEVAR; thoracic aortic aneurysm; thoracic endovascular aortic repair; traumatic aortic injury
类别
资金
- Cook Medical
- Medtronic, Inc.
- Terumo Aortic
- W.L. Gore Associates
This study aimed to evaluate practice patterns and short-term outcomes of TEVAR based on data from an international vascular registry collaboration. The results showed variations in the distribution of TEVAR procedures and patient outcomes among different pathologies. A common core dataset is proposed to achieve harmonization of registry-based quality outcome measures for TEVAR.
Objective: To assess practice patterns and short-term outcome after thoracic endovascular aortic repair (TEVAR), based on an international vascular registry collaboration. Summary Background Data: TEVAR has become the primary surgical treatment modality for descending aortic pathologies, and has expanded to new patient cohorts, including the elderly. Methods: Data on thoracic aortic aneurysms (TAA), type B aortic dissections (TBAD), and traumatic aortic injuries (TAI) treated with TEVAR from 2012 to 2016 were retrieved from registries and centers in 13 countries. Results: Nine-thousand five-hundred eighteen TEVAR for TAA (n = 4436), TBAD (n = 3976) and TAI (n = 1106) were included. The distribution of TEVAR procedures per pathology varied, with TAA repair constituting from 40% of TEVARs in the US to 72% in the UK (P < 0.001). Mean intact TAA (iTAA) diameter varied from 59 (US) to 69 mm (Nancy, France) (P < 0.001), 25.3% of patients having a diameter of <60 mm. Perioperative mortality after iTAA repair was 4.9%; combined mortality, stroke, paraplegia, and renal replacement therapy outcome was 12.8%. 18.6% of iTAA patients were >= 80 years old. Mortality was higher in this group (7.2%) than in patients <80 (3.8%) (P < 0.001). After rTAA repair, perioperative mortality was 26.8%. Mortality was 9.7% after acute (within 14 days from onset of dissection) and 3.0% after chronic TBAD repair (P < 0.001). Mortality after TAI was 7.8%, and depended on injury severity (grade IV (free rupture) 20.9%). Conclusions: This registry collaboration provides a unique platform to evaluate cross-border patterns of use and outcomes of TEVAR. A common core dataset is proposed, to achieve harmonization of registry-based quality outcome measures for TEVAR.
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