Abstract 17850: Trends in Repair of Intact and Ruptured Descending Thoracic Aortic Aneurysms in the United States: A Population-Based Analysis
Objectives: The aim of this study was to evaluate trends and outcomes of descending thoracic aortic aneurysm (DTAA) repair in the United States.
Methods: Adults with DTAA admitted between 1998-2008 were identified in the Nationwide Inpatient Sample. To limit confounding, patients with connective tissue disorders, aortic dissection, or thoracoabdominal aneurysms were excluded. Stratification was based on intact versus ruptured DTAA. Standardized annual rates were calculated based on U.S. Census Bureau population estimates. Logistic regression analysis incorporating multiple patient, operative, and hospital variables was used for risk adjustment.
Results: A total of 20,568 DTAA patients (intact: 17,780; ruptured: 2,788) underwent repair. Annual rates of both intact and ruptured DTAA repairs increased significantly over the study period (intact: 2.2 to 10.6 per 1 million; ruptured: 0.8 to 1.3 per 1 million; p<0.05) (Figure). Operative mortality decreased from 10.3% to 3.1% for intact DTAA repair (p<0.001). Similarly, operative mortality decreased from 52.6% to 23.4% for ruptured DTAA repair (p<0.001). These findings persisted after risk adjustment. The utilization of TEVAR increased steadily since 2005, and by 2008, TEVAR comprised the majority of repairs in each group (intact: 58%; ruptured: 55%).
Conclusions: This large-cohort, population-based analysis demonstrates a significant increase in rates of intact and ruptured DTAA repair in the last decade in the United States, with an overall increase in utilization of TEVAR. In addition, operative mortality has declined substantially for both intact and ruptured repairs. These data are promising and suggest that recognized changes in the management of aortic disease, including better imaging technology and the progressive adoption of TEVAR, have led to appreciable nationwide changes in outcomes of DTAA repair.
- © 2012 by American Heart Association, Inc.