Long-term clinical outcomes of 1020 open repairs of descending thoracic and thoracoabdominal aortic aneurysms.
Academic Article
Overview
abstract
OBJECTIVE: To assess long-term survival and operative outcomes of open descending thoracic aneurysm (DTA) and thoracoabdominal aortic aneurysm (TAAA) repair at a high-volume center. METHODS: We identified all consecutive patients undergoing DTA/TAAA repair between 1997 and 2023 and stratified based on aneurysm extent. Operative outcomes were assessed by univariable and multivariable analysis. Long-term survival was estimated by Kaplan-Meier method. RESULTS: Of 1020 patients, 273 had DTA and 747 had TAAA (53.1% extent I, 18.5% extent II, 20.2% extent III, 7.6% extent IV, and 5% extent V). Operative mortality (OM) was 4.6% overall, 5.1% in the DTA group, and 4.4% in the TAAA group. The incidence of myocardial infarction was 0.5%; stroke, 1.8%; tracheostomy, 6.9%; dialysis, 4.8%; and paraplegia, 1.3%. On multivariable analysis, diabetes (odds ratio [OR], 2.48; 95% confidence interval [CI], 1.20-5.13; P = .014) and renal insufficiency (OR, 3.17; 95% CI, 1.63-6.13; P < .001) were associated with OM. In the TAAA group, extent II aneurysm (OR, 3.56; 95% CI, 1.59-7.96; P = .002) was associated with OM. The median follow-up was 6.72 (95% CI, 5.73-7.81) years. Five- and 10-year survival were 67.2% and 48.2% for the DTA group and 69.9% and 47.5% for the TAAA group. In the TAAA group, 5- and 10-year survival were 76.4% and 49.4% for extent I, 62.5% and 43.3% for extent II, 60.1% and 45.6% for extent III, and 72.6% and 47.4% for extent IV. Age (hazard ratio [HR], 1.04; 95% CI, 1.02-1.05; P < .001), chronic obstructive pulmonary disease (HR, 1.55; 95% CI, 1.25-1.92; P < .001), diabetes (HR, 1.5; 95% CI, 1.09-2.07; P = .013), renal insufficiency (HR, 1.47; 95% CI, 1.18-1.85; P < .001), shock (HR, 1.83; 95% CI, 1.19-2.81; P = .006), and urgent/emergent surgery (HR, 1.27; 95% CI, 1.03-1.58; P = .027) were associated with long-term mortality. CONCLUSIONS: At experienced centers, operative outcomes and long-term survival after open DTA/TAAA repair are encouraging. Short-term outcomes are dependent on preoperative risk factors and aneurysm extent, while long-term survival is dependent on age and chronic comorbidities.
