Thirty-day outcomes of endovascular repair of Stanford type B aortic dissection in patients with chronic obstructive pulmonary disease.

Background: Thoracic Endovascular Aortic Repair (TEVAR) has revolutionized the surgical treatment for Stanford type B aortic dissection (TBAD). While chronic obstructive pulmonary disease (COPD) is associated with worse outcomes in major surgeries, the specific outcomes of TEVAR in patients with COPD have not been extensively explored. This study aimed to evaluate the 30-day postoperative outcomes of COPD patients undergoing TEVAR for TBAD utilizing data from a multi-institutional national registry.

Methods: Patients who underwent TEVAR for TBAD were identified in the ACS-NSQIP database from 2005 to 2022. A 1:3 propensity-score matching was used to match demographics and preoperative characteristics between patients with and without COPD. Thirty-day postoperative outcomes were compared.

Results: There were 172 (9.56%) and 1628 (90.44%) COPD and non-COPD patients who underwent TEVAR for TBAD, respectively. Patients with COPD had a higher comorbidity burden. After the propensity-score matching, all 172 COPD patients were matched to 440 non-COPD patients. COPD and non-COPD patients had comparable mortality rates (10.12% vs 6.82%, p = .18). However, COPD patients had a higher risk of pulmonary complications (20.83% vs 13.18%, p = .02). All other 30-day outcomes were similar between the two groups.

Conclusion: COPD patients had 58.04% higher pulmonary complications while all other 30-day outcomes were comparable to their non-COPD counterparts. Therefore, close monitoring and timely intervention for pulmonary complications in COPD patients can be important after TEVAR for TBAD. Future studies should investigate long-term outcomes among these COPD patients.