Impact of Aetiology on Short- and Long-term Outcomes in Open Descending and Thoracoabdominal Aneurysm Repair

Overview

Journal Interdiscip Cardiovasc Thorac Surg

Publisher Oxford University Press

Specialties Cardiology & Vascular Diseases
General Surgery
Pulmonary Medicine

Date 2024 Dec 10

PMID 39657241

Authors

Joshua R Chen

Christopher Pritting

Vishal N Shah

Colin King

Jacqueline McGee

Konstadinos A Plestis

Affiliations

Soon will be listed here.

Abstract

Objectives: We analysed the impact of chronic type B aortic dissection (cTBAD) and degenerative aneurysm (DA) on the short- and long-term outcomes of patients undergoing open descending thoracic aortic aneurysm and thoracoabdominal aortic aneurysm repair.

Methods: We performed a retrospective analysis of a prospectively maintained aortic database. From 1999 to 2023, 245 patients underwent open descending thoracic aortic aneurysm or thoracoabdominal aortic aneurysm repair. We compared preoperative comorbidities, postoperative complications and operative and long-term mortality for patients with cTBAD (120 patients, 49%) and DA (125 patients, 51%).

Results: Patients with cTBAD were significantly younger, more likely to be male and less likely to have comorbidities including diabetes, chronic obstructive pulmonary disease and coronary artery disease. There were no statistically significant differences in the incidence of operative mortality between cTBAD (7.5%) and DA patients (11.2%) (P = 0.44). Survival at 1, 5, 10 and 15 years for cTBAD versus DA patients was 90% versus 76%, 79% versus 59%, 59% versus 42% and 50% versus 29%, respectively (P < 0.01); however, this lost statistical significance in the Cox regression (P = 0.86). Following multivariable analysis, older age, female gender, coronary artery disease, urgent or emergent procedure and descending thoracic aortic aneurysm were independent predictors of long-term outcomes.

Conclusions: There were no statistically significant differences in the incidence of postoperative complications, operative deaths and long-term survival between cTBAD and DA patients.

Irb Number: (#20D.802), Obtained: 1/31/23.

References

Bavaria J, Appoo J, Makaroun M, Verter J, Yu Z, Mitchell R . Endovascular stent grafting versus open surgical repair of descending thoracic aortic aneurysms in low-risk patients: a multicenter comparative trial. J Thorac Cardiovasc Surg. 2007; 133(2):369-77. DOI: 10.1016/j.jtcvs.2006.07.040. View

Cowan Jr J, Dimick J, Henke P, Huber T, Stanley J, Upchurch Jr G . Surgical treatment of intact thoracoabdominal aortic aneurysms in the United States: hospital and surgeon volume-related outcomes. J Vasc Surg. 2003; 37(6):1169-74. DOI: 10.1016/s0741-5214(03)00085-5. View

Stoecker J, Wang G . Epidemiology of thoracoabdominal aortic aneurysms. Semin Vasc Surg. 2021; 34(1):18-28. DOI: 10.1053/j.semvascsurg.2021.02.001. View

Harky A, Othman A, Shaw M, Nawaytou O, Harrington D, Kuduvalli M . Contemporary results of open thoracic and thoracoabdominal aortic surgery in a single United Kingdom center. J Vasc Surg. 2020; 73(5):1525-1532.e4. DOI: 10.1016/j.jvs.2020.09.027. View

Oh A, Lim S, Sung K, Lee S, Lee J . Outcomes of open repair for descending thoracic and thoracoabdominal aortic aneurysm in recent 10 years: experience of a high-volume centre in Korea. Eur J Cardiothorac Surg. 2023; 64(4). DOI: 10.1093/ejcts/ezad338. View

Estrera A, Jan A, Sandhu H, Shalhub S, Medina-Castro M, Nguyen T . Outcomes of open repair for chronic descending thoracic aortic dissection. Ann Thorac Surg. 2015; 99(3):786-93. DOI: 10.1016/j.athoracsur.2014.08.077. View

Conway A, Sadek M, Lugo J, Pillai J, Pellet Y, Panagopoulos G . Outcomes of open surgical repair for chronic type B aortic dissections. J Vasc Surg. 2014; 59(5):1217-23. DOI: 10.1016/j.jvs.2013.11.002. View

Polanco A, DAngelo A, Shea N, Allen P, Takayama H, Patel V . Increased hospital volume is associated with reduced mortality after thoracoabdominal aortic aneurysm repair. J Vasc Surg. 2020; 73(2):451-458. DOI: 10.1016/j.jvs.2020.05.027. View

Conrad M, Chung T, Cambria M, Paruchuri V, Brady T, Cambria R . Effect of chronic dissection on early and late outcomes after descending thoracic and thoracoabdominal aneurysm repair. J Vasc Surg. 2010; 53(3):600-7. PMC: 3780568. DOI: 10.1016/j.jvs.2010.09.053. View

10.

Boufi M, Patterson B, Loundou A, Boyer L, Grima M, Loftus I . Endovascular Versus Open Repair for Chronic Type B Dissection Treatment: A Meta-Analysis. Ann Thorac Surg. 2018; 107(5):1559-1570. DOI: 10.1016/j.athoracsur.2018.10.045. View

11.

Chiesa R, Tshomba Y, Civilini E, Marone E, Bertoglio L, Baccellieri D . Open repair of descending thoracic aneurysms. HSR Proc Intensive Care Cardiovasc Anesth. 2013; 2(3):177-90. PMC: 3484579. View

12.

Cook I, Green S, Rebello K, Zhang Q, Glover V, Zea-Vera R . Comparison of open thoracoabdominal repair for chronic aortic dissections and aneurysms. J Vasc Surg. 2024; 80(2):323-335. DOI: 10.1016/j.jvs.2024.03.026. View

13.

Schmoker J, McPartland K, Fellinger E, Boyum J, Trombley L, Ittleman F . Matrix metalloproteinase and tissue inhibitor expression in atherosclerotic and nonatherosclerotic thoracic aortic aneurysms. J Thorac Cardiovasc Surg. 2007; 133(1):155-61. DOI: 10.1016/j.jtcvs.2006.07.036. View

14.

Tong M, Eagleton M, Roselli E, Blackstone E, Xiang F, Ibrahim M . Outcomes of Open Versus Endovascular Repair of Descending Thoracic and Thoracoabdominal Aortic Aneurysms. Ann Thorac Surg. 2021; 113(4):1144-1152. DOI: 10.1016/j.athoracsur.2021.04.100. View

15.

Golledge J, Norman P . Atherosclerosis and abdominal aortic aneurysm: cause, response, or common risk factors?. Arterioscler Thromb Vasc Biol. 2010; 30(6):1075-7. PMC: 2874982. DOI: 10.1161/ATVBAHA.110.206573. View

16.

Murana G, Castrovinci S, Kloppenburg G, Yousif A, Kelder H, Schepens M . Open thoracoabdominal aortic aneurysm repair in the modern era: results from a 20-year single-centre experience. Eur J Cardiothorac Surg. 2015; 49(5):1374-81. DOI: 10.1093/ejcts/ezv415. View

17.

Kolbel T, Tsilimparis N, Wipper S, Larena-Avellaneda A, Diener H, Carpenter S . TEVAR for chronic aortic dissection - is covering the primary entry tear enough?. J Cardiovasc Surg (Torino). 2014; 55(4):519-27. View

18.

Ouzounian M, Tadros R, Svensson L, Lyden S, Oderich G, Coselli J . Thoracoabdominal Aortic Disease and Repair: JACC Focus Seminar, Part 3. J Am Coll Cardiol. 2022; 80(8):845-856. DOI: 10.1016/j.jacc.2021.05.056. View

19.

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

20.

Tanaka A, Leonard S, Sandhu H, Afifi R, Miller 3rd C, Charlton-Ouw K . Open Descending and Thoracoabdominal Aortic Repairs in Patients Younger Than 50 Years Old. Ann Thorac Surg. 2019; 108(3):693-699. DOI: 10.1016/j.athoracsur.2019.03.058. View