Open Thoracoabdominal Aortic Aneurysm Repair: Does Chronic Dissection Differ From Aneurysm?

Aortic dissection is common in patients undergoing open surgical repair of thoracoabdominal aortic aneurysm (TAAA). Most often, this manifests as chronic with progressive dilatation. Because contemporary outcomes are not clearly understood, we compared patient characteristics and after TAAA between those non-dissection aneurysm. We retrospectively analyzed data from 3700 repairs performed within a single practice. Operations were for nondissection 2328 (62.9%), 1185 (32.0%), acute/subacute 187 (5.1%). Outcomes included operative mortality adverse event, composite variable comprising death persistent (present at discharge) stroke, paraplegia, paraparesis, renal failure necessitating dialysis. Binomial logistic regression identified independent predictors events. Competing risk analysis was to determine cumulative incidence death, failure, survival free failure. Survival using Cox adjustment age, sex, hereditary thoracic disease, disease type, coronary artery kidney obstructive pulmonary disease. Compared aneurysms, younger, had fewer atherosclerotic factors, more likely have heritable undergo extent II (Table). The overall rate 8.5% (n = 314); 9.1% 211) 6.9% 82) dissection, which differed significantly (P .03). Adverse events lowest cases 150, 12.7%), including 22 (1.9%) paraplegia. Chronic predictive .5) or .6). Operative events, respectively, independently predicted by rupture (odds ratio [OR], 2.74; 2.63), emergency OR, 2.30; 1.94), (OR, 1.70; 1.91), 1.59, 1.71), increasing age 1.04/year; 1.04/year), cross-clamp time 1.01/minute; 1.02/minute). Patients lower 10-year (42% vs 69%), but frequent (6% 3%) than < .001; Figure). difference no longer significant adjustment. vary type. Rupture diseases most commonly occur mortality. Repair associated low rates mortality, along reasonable late excellent long-term durability.TablePreoperative characteristics, details, early 3513 (TAAA) stratified typeChronic 1185)Nondissection 2328)P value*Age, years57 [47-66]70 [65-75]<.001Male sex886 (74.8)1299 (55.8)<.001Heritable disease465 (39.2)114 (4.9)<.001Coronary disease273 (23.0)972 (41.8)<.001Chronic (estimated glomerular filtration <60)283 (23.4)(n 1100)1091 (46.9)(n 2136)<.001Maximum distal diameter, cm6.2 [5.5-7.1] 1081)6.3 [5.6-7.3] 2045).3Rupture36 (3.0)176 (7.6)<.001Emergency repair65 (5.5)225 (9.7).01Extent repair557 (47.0)600 (25.8)<.001Aortic clamp time, minutes61 [48-80] 1177)46 [35-59] 2318)<.001Prior repair250 (21.1)625 (26.8)<.001Adverse eventa150 (12.7)373 (16.0).008Operative death82 (6.9)211 (9.1).03Persistent paraplegia22 (1.9)79 (3.4).01Persistent failure59 (5.0)160 (6.9).03P values reflect two-way comparison aneurysm.Values number (%) median [interquartile range]. Variables missing clarified available sample size.aAdverse Open table new tab