Abstract
Purpose
Open repair of descending thoracic or thoracoabdominal aortic aneurysm (TAAA) continues to carry a not insignificant operative risk, even in experienced hands. Over the past three decades, there has been considerable improvement in both the mortality and morbidity associated with these procedures. Herein, we describe our operative results and long-term outcomes in patients with chronic type B aortic dissections.
Methods
Review of the aortic surgical database was conducted to identify all consecutive patients who underwent repair of TAAA for chronic type B dissection from May 1997 to March 2018. The primary end point was operative mortality with secondary end points as the composite of major adverse events as well as each of the individual complications.
Results
One hundred and fifty-three patients met inclusion criteria with 54.9% (84/153) having surgery on an elective basis. The mean age was 58.9 years with a majority of male gender—107/153 (69.9%). Eighty-three (54.2%) of the TAAA were extent I, while 36 (23.5%) were extent II and 34 (22.3%) extent III-IV. Operative mortality was 8.5% (13/153) with eight of the deaths in patients who presented with extent II TAAA. On Kaplan-Meier survival analysis, 87.5% (95% confidence interval (CI) 77.9–97.1%) of the elective cohort were alive after 5 years while only 69.9% (CI 55.2–84.6%) of those in need of urgent/emergency intervention survived (p = .039).
Conclusions
In a majority of patients with chronic type B dissections, reproducibly, excellent outcomes can be achieved with relatively low risk of mortality. In the higher risk subsets of patients with extent II TAAA, careful consideration and discussion of expected outcomes will help inform the decision-making process.
Similar content being viewed by others
References
Hanna JM, Andersen ND, Ganapathi AM, McCann RL, Hughes GC. Five-year results for endovascular repair of acute complicated type B aortic dissection. J Vasc Surg. 2014;59:96–106.
Nienaber CA, Kische S, Rousseau H, et al. Endovascular repair of type B aortic dissection: long-term results of the randomized investigation of stent grafts in aortic dissection trial. Circ Cardiovasc Interv. 2013;6:407–16.
Crawford ES, Crawford JL, Safi HJ, et al. Thoracoabdominal aortic aneurysms: preoperative and intraoperative factors determining immediate and long-term results of operations in 605 patients. J Vasc Surg. 1986;3:389–404.
Acher C, Wynn M. Outcomes in open repair of the thoracic and thoracoabdominal aorta. J Vasc Surg. 2010;52:3S–9S.
Escobar GA, Upchurch GR. Management of thoracoabdominal aortic aneurysms. Curr Probl Surg. 2011;48:70–133.
Coselli JS, LeMaire SA, Preventza O, et al. Outcomes of 3309 thoracoabdominal aortic aneurysm repairs. J Thorac Cardiovasc Surg. 2016;151:1323–37.
Murana G, Castrovinci S, Kloppenburg G, et al. Open thoracoabdominal aortic aneurysm repair in the modern era: results from a 20-year single-centre experience. Eur J Cardiothorac Surg. 2016;49:1374–81.
Gambardella I, Gaudino M, Lau C, Munjal M, Elsayed M, Girardi LN. Surgical outcomes of chronic descending dissections: type I versus III DeBakey. Ann Thorac Surg. 2017;104:593–8.
Wynn M, Acher C, Marks E, Acher CW. The effect of intercostal artery reimplantation on spinal cord injury in thoracoabdominal aortic aneurysm surgery. J Vasc Surg. 2016;64:289–96.
Griepp RB, Griepp EB. Spinal cord perfusion and protection during descending thoracic and thoracoabdominal aortic surgery: the collateral network concept. Ann Thorac Surg. 2007;83:S865–9.
Debakey ME, Henly WS, Cooley DA, Morris GC, Crawford ES, Beall AC. Surgical management of dissecting aneurysms of the aorta. J Thorac Cardiovasc Surg. 1965;49:130–49.
Girardi LN, Krieger KH, Altorki NK, Mack CA, Lee LY, Isom OW. Ruptured descending and thoracoabdominal aortic aneurysms. Ann Thorac Surg. 2002;74:1066–70.
Lemaire SA, Jones MM, Conklin LD, et al. Randomized comparison of cold blood and cold crystalloid renal perfusion for renal protection during thoracoabdominal aortic aneurysm repair. J Vasc Surg. 2009;49:11–9.
Coselli JS. The use of left heart bypass in the repair of thoracoabdominal aortic aneurysms: current techniques and results. Semin Thorac Cardiovasc Surg. 2003;15:326–32.
Coselli JS, Green SY, Price MD, et al. Results of open surgical repair in patients with Marfan syndrome and distal aortic dissection. Ann Thorac Surg. 2016;101:2193–201.
Cowan JA, Dimick JB, Henke PK, Huber TS, Stanley JC, Upchurch GR. Surgical treatment of intact thoracoabdominal aortic aneurysms in the United States: hospital and surgeon volume-related outcomes. J Vasc Surg. 2003;37:1169–74.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
Dr. Leonard, Dr. Lau, Dr. Iannacone, Dr. Gaudino, Ms. Munjal and Dr. Girardi declare that they have no conflict of interest.
This study was approved by the institutional review board. The need for individual patient consent was waived.
Rights and permissions
About this article
Cite this article
Leonard, J.R., Lau, C., Iannacone, E.M. et al. Surgery for chronic type B dissection with aneurysmal degeneration. Indian J Thorac Cardiovasc Surg 35 (Suppl 2), 169–173 (2019). https://doi.org/10.1007/s12055-018-0691-6
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12055-018-0691-6