A Quarter Century of Organ Protection in Open Thoracoabdominal Repair. Issue 4 (October 2015)

• Record Type: Journal Article
• Authors: Estrera, Anthony L.; Sandhu, Harleen K.; Charlton-Ouw, Kristofer M.; Afifi, Rana O.; Azizzadeh, Ali; Miller, Charles C.; Safi, Hazim J.
• Is Part Of: Annals of surgery. Volume 262:Issue 4(2015:Oct.)
• Publication Date: 2015-10
• Subjects: DAP -- descending thoracic aortic aneurysm -- distal aortic perfusion -- DTAA -- TAAA -- thoracoabdominal aortic aneurysm -- thoracoabdominal repair; Surgery -- Periodicals; 617.005
• DOI: 10.1097/SLA.0000000000001432
• Languages: English
• ISSNs: 0003-4932

Abstract

Abstract : Introduction: Thoracoabdominal aortic aneurysm (TAAA) remains a challenging problem. We sought to examine our experience with thoracic and thoracoabdominal aortic repairs over a 24-year period. Methods: Patient information was collected in a prospective database and analyzed retrospectively. Univariate and multivariable analysis was performed. Results: Between January 1991 and December 2014, we repaired 1896 descending thoracic (DTAA) or TAAA in 1795 patients. Mean age was 64.2 ± 13.8, and 702 (37%) were women. Of 1896 operations, 646 (34.1%) were DTAA, 316 (16.7%) TAAA extent I, 310 (16.4%) TAAA extent II, 187 (9.9%) TAAA extent III, 348 (18.4%) TAAA extent IV, and 112 (5.9%) TAAA extent V. Adjunct [cerebrospinal fluid drainage (CSFD) + distal aortic perfusion (DAP)] was used in 78.4%. Mean preoperative glomerular filtration rate (GFR) was 75.1 ± 14.9 mL/min/1.73 m 2 . Renal dysfunction occurred in 461 (24.3%). Immediate neurodeficit (IND) occurred in 79 (4.2%) and delayed in 104 (5.5%). Of these, 47/104 (45%) recovered by discharge. Postoperative stroke was 95/1896 (5%). Early mortality was 302/1896 (15.9%). Mortality with GFR >95.3 was 28/457 (6.1%), and 131/432 (30.3%) was with GFR < 48.3 ( P < 0.0001). Predictors of early mortality were age ( P < 0.02), GFR ( P < 0.0001), TAAA2 or 3 ( P = 0.001), coronary artery disease ( P = 0.001), and emergency ( P < 0.0001). Conclusions: Open DTAA and TAAA repair can be performed with acceptable early and late outcomes. This study provides important early- and long-term data on open repair, allowing for better risk stratification of patients with DTAA and TAAA. It is the high-risk subgroup that can now be targeted for endovascular techniques. Abstract : Supplemental Digital Content is available in the text