Trends and Outcomes of Elective Thoracic Aortic Repair and Acute Thoracic Aortic Syndromes in the United States |
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| Authors: | Ayman Elbadawi Islam Y. Elgendy Ernesto Jimenez Mohmed A. Omer Hend I. Shahin Gbolahan O. Ogunbayo David Paniagua Hani Jneid |
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| Affiliation: | 1. Department of Cardiovascular Medicine, University of Texas Medical Branch, Galveston;2. Division of Cardiology, Weill Cornell Medicine-Qatar, Doha, Qatar;3. Division of Cardiothoracic Surgery, Baylor School of Medicine, Houston, Tex;4. Division of Cardiovascular Medicine, Mayo Clinic, Rochester, Minn;5. Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston;6. Department of Cardiovascular Medicine, University of Kentucky, Lexington;7. Division of Cardiology, Baylor School of Medicine, Houston, Tex;1. Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, University of Florida, Gainesville, Florida;2. Division of Nephrology, University of Chicago, Illinois;3. Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, Florida;1. Department of Internal Medicine, Yale School of Medicine, New Haven, Conn;2. Department of Pharmacy and Health Systems Science, Northeastern School of Pharmacy, Boston, Mass;3. Leon H. Charney Division of Cardiology, Department of Medicine;4. Division of Healthcare Delivery Science, Department of Population Health, New York University School of Medicine, New York, NY;5. Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester;1. Center for Medical Training, Ehime Seikyo Hospital, Japan;2. Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, Japan;2. University of Arizona Department of Medicine, Tucson;4. Department of Medicine, New York Medical College/Westchester Medical Center Health Care System, Valhalla, NY;1. Department of Philosophy, Texas Tech University, Lubbock;2. Texas Tech University Health Sciences Center, School of Medicine, Lubbock |
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| Abstract: | BackgroundThere is a paucity of data on the contemporary outcomes and trends of elective thoracic aortic aneurysm repair and aneurysm-associated acute aortic syndrome.MethodsWe queried the National Inpatient Sample (NIS) database years 2012-2016 to identify hospitalizations for elective thoracic aortic aneurysm repair and aneurysm-associated acute aortic syndrome. The main study outcome was in-hospital mortality.ResultsThe analysis yielded 24,295 hospitalizations for elective thoracic aortic aneurysm repair and 8875 hospitalizations for aneurysm-associated acute aortic syndrome. The number of hospitalizations for elective aortic repair significantly increased from 4375 in 2012 to 5450 in 2016 (Ptrend = .01). The number of hospitalizations for acute aortic syndrome numerically increased from 1545 in 2012 to 2340 in 2016 (Ptrend = .10). Overall in-hospital mortality for elective aortic repair was 2.4% with no change over time. In-hospital mortality for acute aortic rupture was 39.4% and for acute aortic dissection was 6.2% with no change over time. Hospitalizations for elective aortic repair had lower incidence of complications compared with those for aneurysm-associated acute aortic syndrome, including cardiogenic shock, cardiac arrest, acute stroke, and shorter length of stay. Factors associated with higher mortality among admissions undergoing elective aortic repair included older age, heart failure, valvular disease, and chronic kidney disease. Older age, coagulopathy, and fluid/ electrolytes disorders were associated with increased mortality among those with acute aortic syndrome.ConclusionContemporary elective thoracic aortic aneurysm repair is associated with lower in-hospital mortality and morbidity when compared with a clinical presentation for an aneurysm-associated acute aortic syndrome. This should be taken into account when deciding the timing of elective aortic aneurysm repair and balancing the risks and benefits. |
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| Keywords: | Acute aortic syndrome Aortic aneurysm Aortic repair |
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