Open repair of thoracoabdominal aortic aneurysms (TAAA) that have developed secondary to chronic aortic dissection (CD) is often more complex than repair of degenerative aneurysms (DA). However, the literature is conflicted regarding the effect of CD on peri-operative and long-term outcomes after open TAAA repair. The goal of this study was to determine if CD pathology predicts negative outcomes after TAAA repair.
All open type I-III TAAA repairs performed from 1987-2015 were evaluated using a single institutional database. Endpoints included in-hospital death, spinal cord ischemia (SCI), major adverse events (MAE) and long-term survival. Repairs performed for rupture or acute dissection were excluded. Univariate analysis was conducted using the Fisher’s exact test for categorical variables and the Wilcoxon rank-sum test for continuous variables. Logistic multivariable regression was used for the in-hospital endpoints and survival analyses were performed with Cox Proportional Hazards modelling and Kaplan-Meier techniques.
Four hundred fifty-three patients underwent an intact open type I-III TAAA repair during the study period. Ninety (20%) were performed on patients with CD. Those with CD were more likely to be younger (59 versus 72 years, p<.001), have an extent 2 lesion (30% versus 16%, p<.001), have Marfan's syndrome (18% versus 0.6%, p<.001), and were less likely to have coronary artery disease [(CAD), 28% versus 25%, p=.01] or chronic obstructive pulmonary disease [(COPD), 12% versus 27%, p=.004] when compared to DA. Twelve percent of patients with CD died during the peri-operatively compared to 6% of those with DA (p=.03). Eighteen percent of CD patients suffered from SCI compared to 12% of DA patients (p=.2). Fifty-nine CD patients suffered a MAE compared to 42% of those with DA (p=.006). Multivariable analysis revealed CD to be an independent predictor of perioperative death (AOR: 3.1, 95% CI:1.2-8.0, p=.02) with adjustment for age and Crawford extent. CD was also found to be independently predictive of any major adverse event (MAE) (AOR: 2.5, 95% CI: 1.4-4.6, p=.002). CD was not associated with increased risk of SCI (AOR: 1.4, 95% CI: 0.6-3.2, p=.4). There was a long-term survival advantage in the CD cohort in the unadjusted (log-rank p=.009) but not the adjusted analysis (CD AHR: 0.9, 95% CI: 0.6-1.4, p=.7).
When analysis is limited to type I-III TAAA, open repair of patient with CD leads to increased perioperative mortality and morbidity when compared to DA. However, age adjusted long-term survival is no different between the two cohorts.
Copyright © 2020. Published by Elsevier Inc.