TY - JOUR
T1 - Operative outcomes after open repair of descending thoracic aortic aneurysms in the era of endovascular surgery
AU - Sadek, Mostafa
AU - Abjigitova, Djamila
AU - Pellet, Yonni
AU - Rachakonda, Aditya
AU - Panagopoulos, Georgia
AU - Plestis, Konstadinos
PY - 2014/5
Y1 - 2014/5
N2 - Background Since the advent of endovascular techniques for repair of descending thoracic aortic aneurysms (DTAAs), there has been a relative paucity of current data for open repairs. The purpose of this study was to assess the operative and long-term outcomes in a contemporary series of open repairs of DTAAs. Methods We conducted a retrospective review of 68 patients (63 ±14.5 years) who underwent DTAA repairs between January 1999 and December 2010. Forty-two patients (62%) were male, 16 (24%) had chronic obstructive pulmonary disease, 7 (10%) required dialysis preoperatively, 11 (16%) had contained rupture, 25 (37%) had previous cardioaortic operations, and 10 (15%) had previous aortic arch replacement (stage 1 elephant trunk). The entire descending thoracic aorta was replaced in 34 patients (50%). Cardiopulmonary bypass was used in 64 patients (94%) and deep hypothermic arrest in 22 (32%). Results In-hospital mortality was 3% (2 patients). There was no immediate paraplegia. Delayed paraplegia developed in 1 patient (1.5%). Postoperative stroke occurred in 3 patients (4.4%), and 20 (29%) required prolonged ventilatory support (intubation ≥48 hours). New-onset renal insufficiency (creatinine ≥2.5 mg/dL) developed postoperatively in 6 patients (9%), and 1 (1.5%) required temporary dialysis. The median follow-up time was 5.8 ± 3.8 years. Sixteen of the 66 operative survivors (24.2%) died during follow-up. Probability of survival was 82% ± 0.05% at 5 years and 67% ± 0.07% at 10 years. Reintervention was necessary in 4 patients (6%). Freedom from reintervention was 98% ± 0.02% at 5 years and 89% ± 0.06% at 10 years. The univariable predictor of long-term death was postoperative reintubation (p < 0.05). Conclusions In the era of endovascular repair of DTAAs, operative death and morbidity outcomes for open repairs are observed to be low. In addition to good long-term survival rates, open repairs are durable, as evidenced by low reintervention rates.
AB - Background Since the advent of endovascular techniques for repair of descending thoracic aortic aneurysms (DTAAs), there has been a relative paucity of current data for open repairs. The purpose of this study was to assess the operative and long-term outcomes in a contemporary series of open repairs of DTAAs. Methods We conducted a retrospective review of 68 patients (63 ±14.5 years) who underwent DTAA repairs between January 1999 and December 2010. Forty-two patients (62%) were male, 16 (24%) had chronic obstructive pulmonary disease, 7 (10%) required dialysis preoperatively, 11 (16%) had contained rupture, 25 (37%) had previous cardioaortic operations, and 10 (15%) had previous aortic arch replacement (stage 1 elephant trunk). The entire descending thoracic aorta was replaced in 34 patients (50%). Cardiopulmonary bypass was used in 64 patients (94%) and deep hypothermic arrest in 22 (32%). Results In-hospital mortality was 3% (2 patients). There was no immediate paraplegia. Delayed paraplegia developed in 1 patient (1.5%). Postoperative stroke occurred in 3 patients (4.4%), and 20 (29%) required prolonged ventilatory support (intubation ≥48 hours). New-onset renal insufficiency (creatinine ≥2.5 mg/dL) developed postoperatively in 6 patients (9%), and 1 (1.5%) required temporary dialysis. The median follow-up time was 5.8 ± 3.8 years. Sixteen of the 66 operative survivors (24.2%) died during follow-up. Probability of survival was 82% ± 0.05% at 5 years and 67% ± 0.07% at 10 years. Reintervention was necessary in 4 patients (6%). Freedom from reintervention was 98% ± 0.02% at 5 years and 89% ± 0.06% at 10 years. The univariable predictor of long-term death was postoperative reintubation (p < 0.05). Conclusions In the era of endovascular repair of DTAAs, operative death and morbidity outcomes for open repairs are observed to be low. In addition to good long-term survival rates, open repairs are durable, as evidenced by low reintervention rates.
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U2 - 10.1016/j.athoracsur.2014.01.046
DO - 10.1016/j.athoracsur.2014.01.046
M3 - Article
C2 - 24636705
AN - SCOPUS:84899987794
SN - 0003-4975
VL - 97
SP - 1562
EP - 1567
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 5
ER -