Thoracoabdominal aortic replacement in patients aged 50 and younger
- 129 Downloads
Open repair of a thoracoabdominal aortic aneurysm (TAAA) has been regarded as one of the most invasive procedures in cardiovascular surgery. Conversely, endovascular technology currently enables the repair of the thoracoabdominal aorta, and this approach is less invasive. However, the long-term durability of this method of endovascular repair remains unknown. This investigation retrospectively analyzed the long-term durability of thoracoabdominal aorta repair in patients aged 50 and younger.
Patients and methods
Since 1995, 100 patients aged 50 and younger underwent thoracoabdominal aortic replacement at our institution. There were 63 males, and the average age was 38 ± 7. Ninety-six had aortic dissection as an aortic pathology. Marfan syndrome was found in 61 patients, Loeys–Dietz in 10, Acta 2 mutations in 4, aortitis in 2, and Ehlers–Danlos syndrome in 1. There were 2 patients with a type I TAAA, 56 with a type II, 33 with a type III, and 9 with a type IV.
There were 3 hospital deaths (3%), of which 2 were emergent cases. Spinal cord injury occurred in 1 patient (1%). Two patients (2%) had wound complications. Three patients suffered cerebral hemorrhage and 1 had an intramedullary infection, of which all were associated with cerebrospinal fluid drainage. The 3-year survival rate after the operation was 94%, that of 5 years was 94%, and that of 10 years was 91%.
Results of thoracoabdominal aortic replacement in patients aged 50 and younger were favorable. While spinal cord complications were rare, cerebrospinal drainage revealed several complications in this series. Evolving endovascular repair needs to be compared with these results, especially in patients aged 50 and younger.
KeywordsConnective tissue disease Thoracoabdominal aortic replacement
- 4.Minatoya K, Seike Y, Itonaga T, Oda T, Inoue Y, Kawamoto N, Miura S, Tanaka H, Sasaki H, Kobayashi J. Straight incision for extended descending and thoracoabdominal aortic replacement: novel and simple exposure with rib-cross thoracotomy. Interact Cardiovasc Thorac Surg. 2016;23(3):367–70.CrossRefPubMedGoogle Scholar
- 5.Di Luozzo G, Geisbüsch S, Lin HM, Bischoff MS, Schray D, Pawale A, Griepp RB. Open repair of descending and thoracoabdominal aortic aneurysms and dissections in patients aged younger than 60 years: superior to endovascular repair? Ann Thorac Surg. 2013;95(1):12–9 (discussion 19).CrossRefPubMedGoogle Scholar
- 13.Tanaka H, Minatoya K, Matsuda H, Sasaki H, Iba Y, Oda T, Kobayashi J. Embolism is emerging as a major cause of spinal cord injury after descending and thoracoabdominal aortic repair with a contemporary approach: magnetic resonance findings of spinal cord injury. Interact Cardiovasc Thorac Surg. 2014;19(2):205–10.CrossRefPubMedGoogle Scholar
- 14.Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE Jr, Eagle KA, Hermann LK, Isselbacher EM, Kazerooni EA, Kouchoukos NT, Lytle BW, Milewicz DM, Reich DL, Sen S, Shinn JA, Svensson LG, Williams DM, American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines; American Association for Thoracic Surgery; American College of Radiology; American Stroke Association; Society of Cardiovascular Anesthesiologists; Society for Cardiovascular Angiography and Interventions; Society of Interventional Radiology; Society of Thoracic Surgeons; Society for Vascular Medicine. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the diagnosis and management of patients with thoracic aortic disease. A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. J Am Coll Cardiol. 2010;55(14):e27–e129 (Erratum in: J Am Coll Cardiol. 2013 Sep 10;62(11):1039–40).CrossRefGoogle Scholar
- 15.Erbel R, Aboyans V, Boileau C, Bossone E, Bartolomeo RD, Eggebrecht H, Evangelista A, Falk V, Frank H, Gaemperli O, Grabenwöger M, Haverich A, Iung B, Manolis AJ, Meijboom F, Nienaber CA, Roffi M, Rousseau H, Sechtem U, Sirnes PA, Allmen RS, Vrints CJ, ESC Committee for Practice Guidelines. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J. 2014;35(41):2873–926.CrossRefPubMedGoogle Scholar