A Quarter Century of Organ Protection in Open Thoracoabdominal Repair.
Ann Surg
; 262(4): 660-8, 2015 Oct.
Article
en En
| MEDLINE
| ID: mdl-26366546
ABSTRACT
INTRODUCTION:
Thoracoabdominal aortic aneurysm (TAAA) remains a challenging problem. We sought to examine our experience with thoracic and thoracoabdominal aortic repairs over a 24-year period.METHODS:
Patient information was collected in a prospective database and analyzed retrospectively. Univariate and multivariable analysis was performed.RESULTS:
Between January 1991 and December 2014, we repaired 1896 descending thoracic (DTAA) or TAAA in 1795 patients. Mean age was 64.2â±â13.8, and 702 (37%) were women. Of 1896 operations, 646 (34.1%) were DTAA, 316 (16.7%) TAAA extent I, 310 (16.4%) TAAA extent II, 187 (9.9%) TAAA extent III, 348 (18.4%) TAAA extent IV, and 112 (5.9%) TAAA extent V. Adjunct [cerebrospinal fluid drainage (CSFD)â+âdistal aortic perfusion (DAP)] was used in 78.4%. Mean preoperative glomerular filtration rate (GFR) was 75.1â±â14.9âmL/min/1.73âm. Renal dysfunction occurred in 461 (24.3%). Immediate neurodeficit (IND) occurred in 79 (4.2%) and delayed in 104 (5.5%). Of these, 47/104 (45%) recovered by discharge. Postoperative stroke was 95/1896 (5%). Early mortality was 302/1896 (15.9%). Mortality with GFR >95.3 was 28/457 (6.1%), and 131/432 (30.3%) was with GFRâ<â48.3 (Pâ<â0.0001). Predictors of early mortality were age (Pâ<â0.02), GFR (Pâ<â0.0001), TAAA2 or 3 (Pâ=â0.001), coronary artery disease (Pâ=â0.001), and emergency (Pâ<â0.0001).CONCLUSIONS:
Open DTAA and TAAA repair can be performed with acceptable early and late outcomes. This study provides important early- and long-term data on open repair, allowing for better risk stratification of patients with DTAA and TAAA. It is the high-risk subgroup that can now be targeted for endovascular techniques.
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Aneurisma de la Aorta Torácica
/
Implantación de Prótesis Vascular
Tipo de estudio:
Evaluation_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Límite:
Adult
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Aged
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Aged80
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
Ann Surg
Año:
2015
Tipo del documento:
Article