Differential Impacts of Clinical, Anatomical, and Procedural Factors on Early and Late Mortality Following Open Thoracoabdominal Aortic Repair: a Retrospective Observational Study

Overview

Journal J Cardiothorac Surg

Publisher Biomed Central

Specialties Cardiology & Vascular Diseases
General Surgery
Pulmonary Medicine

Date 2024 Jun 24

PMID 38915060

Authors

Jin Kyoung Kim

Gwan Sic Kim

Woo Seok Kim

Ho Jin Kim

Suk Jung Choo

Joon Bum Kim

Affiliations

Soon will be listed here.

Abstract

Background: The operative outcomes of thoracoabdominal aortic aneurysms (TAAAs) are challenged by high operative mortality and disabling complications. This study aimed to explore the baseline clinical, anatomical, and procedural risk factors that impact early and late outcomes following open repair of TAAAs.

Methods: We reviewed the medical records of 290 patients who underwent open repair of TAAAs between 1992 and 2020 at a tertiary referral center. Determinants of early mortality (within 30 days or in hospital) were analyzed using multivariable logistic regression models, while those of overall follow-up mortality were explored using multivariable Cox proportional hazards models and landmark analyses.

Results: The rates of early mortality and spinal cord deficits were 13.1% and 11.0%, respectively, with Crawford extent II showing the highest rates. In the logistic regression models, older age (P < 0.001), high cardiopulmonary bypass (CPB) time (P < 0.001), and low surgical volume of the surgeon (P < 0.001) emerged as independent factors significantly associated with early mortality. During follow-up (median, 5.0 years; interquartile range, 1.1-7.6 years), 82 late deaths occurred (5.7%/patient-year). Cox proportional hazards models demonstrated that older age (P < 0.001) and low hemoglobin level (P = 0.032) were significant risk factors of overall mortality, while the landmark analyses revealed that the significant impacts of low surgical volume (P = 0.017), high CPB time (P = 0.002), and Crawford extent II (P = 0.017) on mortality only remained in the early postoperative period, without significant late impacts (all P > 0.05).

Conclusion: There were differential temporal impacts of perioperative risk variables on mortality in open repair of TAAAs, with older age and low hemoglobin level having significant impacts throughout the postoperative period, and low surgical volume, high CPB time, and Crawford extent II having impacts in the early postoperative phase.

References

Johnston R, Jones K, Manley D . Confounding and collinearity in regression analysis: a cautionary tale and an alternative procedure, illustrated by studies of British voting behaviour. Qual Quant. 2018; 52(4):1957-1976. PMC: 5993839. DOI: 10.1007/s11135-017-0584-6. View

Coselli J, Conklin L, LeMaire S . Thoracoabdominal aortic aneurysm repair: review and update of current strategies. Ann Thorac Surg. 2002; 74(5):S1881-4; discussion S1892-8. DOI: 10.1016/s0003-4975(02)04139-5. View

Nissinen J, Biancari F, Wistbacka J, Peltola T, Loponen P, Tarkiainen P . Safe time limits of aortic cross-clamping and cardiopulmonary bypass in adult cardiac surgery. Perfusion. 2009; 24(5):297-305. DOI: 10.1177/0267659109354656. View

Hiratzka L, Bakris G, Beckman J, Bersin R, Carr V, Casey Jr D . 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the diagnosis and management of patients with thoracic aortic disease. A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice.... J Am Coll Cardiol. 2010; 55(14):e27-e129. DOI: 10.1016/j.jacc.2010.02.015. View

Yoo J, Kim J, Jung S, Choo S, Chung C, Lee J . Surgical repair of descending thoracic and thoracoabdominal aortic aneurysm involving the distal arch: open proximal anastomosis under deep hypothermia versus arch clamping technique. J Thorac Cardiovasc Surg. 2014; 148(5):2101-7. DOI: 10.1016/j.jtcvs.2014.06.068. View

Wong D, Parenti J, Green S, Chowdhary V, Liao J, Zarda S . Open repair of thoracoabdominal aortic aneurysm in the modern surgical era: contemporary outcomes in 509 patients. J Am Coll Surg. 2011; 212(4):569-79. DOI: 10.1016/j.jamcollsurg.2010.12.041. View

Gaudino M, Benedetto U, Bakaeen F, Rahouma M, Tam D, Abouarab A . Off- Versus On-Pump Coronary Surgery and the Effect of Follow-Up Length and Surgeons' Experience: A Meta-Analysis. J Am Heart Assoc. 2018; 7(21):e010034. PMC: 6404195. DOI: 10.1161/JAHA.118.010034. View

Rhee Y, Park S, Kim T, Kim N, Yang D, Kim J . Pre-sewn Multi-branched Aortic Graft and 3D-Printing Guidance for Crawford Extent II or III Thoracoabdominal Aortic Aneurysm Repair. Semin Thorac Cardiovasc Surg. 2021; 34(3):816-822. DOI: 10.1053/j.semtcvs.2021.03.046. View

Ok Y, Kang S, Kim H, Kim J, Choo S . Comparative outcomes of total arch versus hemiarch repair in acute DeBakey type I aortic dissection: the impact of 21 years of experience. Eur J Cardiothorac Surg. 2021; 60(4):967-975. DOI: 10.1093/ejcts/ezab189. View

10.

Coselli J, Bozinovski J, LeMaire S . Open surgical repair of 2286 thoracoabdominal aortic aneurysms. Ann Thorac Surg. 2007; 83(2):S862-4. DOI: 10.1016/j.athoracsur.2006.10.088. View

11.

Crawford E, Crawford J, Safi H, Coselli J, Hess K, Brooks B . Thoracoabdominal aortic aneurysms: preoperative and intraoperative factors determining immediate and long-term results of operations in 605 patients. J Vasc Surg. 1986; 3(3):389-404. DOI: 10.1067/mva.1986.avs0030389. View

12.

Kim H, Kim J, Kim S, Yun S, Lee S, Lim C . A Risk Prediction Model for Operative Mortality after Heart Valve Surgery in a Korean Cohort. J Chest Surg. 2021; 54(2):88-98. PMC: 8038884. DOI: 10.5090/jcs.20.102. View

13.

Park S, Kim J . An eight-branched aortic graft for reconstruction of visceral and intercostal arteries during extent II thoraco-abdominal aortic surgery. Eur J Cardiothorac Surg. 2017; 53(6):1282-1283. DOI: 10.1093/ejcts/ezx393. View

14.

Coselli J, LeMaire S, Preventza O, de la Cruz K, Cooley D, Price M . Outcomes of 3309 thoracoabdominal aortic aneurysm repairs. J Thorac Cardiovasc Surg. 2016; 151(5):1323-37. DOI: 10.1016/j.jtcvs.2015.12.050. View

15.

LeMaire S, Price M, Green S, Zarda S, Coselli J . Results of open thoracoabdominal aortic aneurysm repair. Ann Cardiothorac Surg. 2013; 1(3):286-92. PMC: 3741780. DOI: 10.3978/j.issn.2225-319X.2012.08.16. View