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Int J Angiol 2018; 27(02): 114-120
DOI: 10.1055/s-0038-1649517
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Open Replacement of the Thoracoabdominal Aorta: Short- and Long-term Outcomes at a Single Institution

Davide Carino
1   Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut
,
Young Erben
1   Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut
2   Department of Vascular Surgery, Yale University School of Medicine, New Haven, Connecticut
,
Mohammad A. Zafar
1   Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut
,
Mrinal Singh
1   Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut
,
Adam J. Brownstein
1   Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut
,
Maryann Tranquilli
1   Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut
,
John Rizzo
1   Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut
3   Department of Economics and Preventive Medicine, Stony Brook University, Stony Brook, New York
,
Bulat A. Ziganshin
1   Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut
4   Department of Surgical Diseases #2, Kazan State Medical University, Kazan, Russia
,
John A. Elefteriades
1   Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut
› Author Affiliations Funding None.
Further Information

Publication History

Publication Date:
23 May 2018 (online)

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Abstract

Background Despite much progress in the surgical and endovascular treatment of thoracoabdominal aortic diseases (TAADs), there is no consensus regarding the optimal approach to minimize operative mortality and end-organ dysfunction. We report our experience in the past 16 years treating TAAD by open surgery.

Methods A retrospective review of all TAAD patients who underwent an open repair since January 2000 was performed. The primary endpoints included early morbidity and mortality, and the secondary endpoints were overall death and rate of aortic reintervention.

Results There were 112 patients treated by open surgery for TAAD. Mean age was 66 ± 10 years and 61 (54%) were male. Seventy-seven (69%) patients had aneurysmal degeneration without aortic dissection and the remaining 35 (31%) had a concomitant aortic dissection. There were 12 deaths (10.7%) and they were equally distributed between the aneurysm and dissection groups (p = 0.8). The mortality for elective surgery was 3.2% (2/61). The rate of permanent paraplegia and stroke were each 2.6% (3/112). The rate of cerebrovascular accident was significantly higher in the dissection group (8.5% vs. 1.2%, p = 0.05). The survival at 1, 5, and 10 years was 80.6, 56.1, and 32.7%, respectively.

Conclusion Our data confirm that open replacement of the thoracoabdominal aorta can be performed in expert centers quite safely. Different aortic pathologies (degenerative aneurysm vs. dissection) do not influence the short- and long-term outcomes. Open surgery should still be considered the standard in the management of TAAD.

Keywords

thoracoabdomnial aortic disease - thoracoabdominal aortic aneurysm
 

  • References

  • 1 De Bakey ME, Cooley DA. Successful resection of aneurysm of thoracic aorta and replacement by graft. J Am Med Assoc 1953; 152 (08) 673-676
    CrossrefPubMedGoogle Scholar
  • 2 Etheredge SN, Yee J, Smith JV, Schonberger S, Goldman MJ. Successful resection of a large aneurysm of the upper abdominal aorta and replacement with homograft. Surgery 1955; 38 (06) 1071-1081
    PubMedGoogle Scholar
  • 3 Crawford ES. Thoraco-abdominal and abdominal aortic aneurysms involving renal, superior mesenteric, celiac arteries. Ann Surg 1974; 179 (05) 763-772
    CrossrefPubMedGoogle Scholar
  • 4 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 (03) 389-404
    CrossrefPubMedGoogle Scholar
  • 5 Cambria RP, Davison JK, Zannetti S. , et al. Clinical experience with epidural cooling for spinal cord protection during thoracic and thoracoabdominal aneurysm repair. J Vasc Surg 1997; 25 (02) 234-241 , discussion 241–243
    CrossrefPubMedGoogle Scholar
  • 6 Coselli JS, LeMaire SA. Left heart bypass reduces paraplegia rates after thoracoabdominal aortic aneurysm repair. Ann Thorac Surg 1999; 67 (06) 1931-1934 , discussion 1953–1958
    CrossrefPubMedGoogle Scholar
  • 7 Griepp RB, Ergin MA, Galla JD, Klein JJ, Spielvogel D, Griepp EB. Minimizing spinal cord injury during repair of descending thoracic and thoracoabdominal aneurysms: the Mount Sinai approach. Semin Thorac Cardiovasc Surg 1998; 10 (01) 25-28
    CrossrefPubMedGoogle Scholar
  • 8 Kouchoukos NT, Daily BB, Rokkas CK, Murphy SF, Bauer S, Abboud N. Hypothermic bypass and circulatory arrest for operations on the descending thoracic and thoracoabdominal aorta. Ann Thorac Surg 1995; 60 (01) 67-76 , discussion 76–77
    CrossrefPubMedGoogle Scholar
  • 9 Schepens MAAM, Defauw JJAM, Hamerlijnck RPHM, Vermeulen FEE. Use of left heart bypass in the surgical repair of thoracoabdominal aortic aneurysms. Ann Vasc Surg 1995; 9 (04) 327-338
    CrossrefPubMedGoogle Scholar
  • 10 Verhoeven EL, Katsargyris A, Bekkema F. , et al. Editor's choice - ten-year experience with endovascular repair of thoracoabdominal aortic aneurysms: results from 166 consecutive patients. Eur J Vasc Endovasc Surg 2015; 49 (05) 524-531
    CrossrefPubMedGoogle Scholar
  • 11 Haulon S, D'Elia P, O'Brien N. , et al. Endovascular repair of thoracoabdominal aortic aneurysms. Eur J Vasc Endovasc Surg 2010; 39 (02) 171-178
    CrossrefPubMedGoogle Scholar
  • 12 Greenberg R, Eagleton M, Mastracci T. Branched endografts for thoracoabdominal aneurysms. J Thorac Cardiovasc Surg 2010; 140 (6, Suppl): S171-S178
    CrossrefPubMedGoogle Scholar
  • 13 Pacini D, Di Marco L, Murana G, Pantaleo A, Leone A, Di Bartolomeo R. Hybrid repair of thoracoabdominal aneurysm: a two-stage approach. Ann Thorac Surg 2013; 96 (04) 1496-1498
    CrossrefPubMedGoogle Scholar
  • 14 Chiesa R, Tshomba Y, Melissano G. , et al. Hybrid approach to thoracoabdominal aortic aneurysms in patients with prior aortic surgery. J Vasc Surg 2007; 45 (06) 1128-1135
    CrossrefPubMedGoogle Scholar
  • 15 Black SA, Wolfe JH, Clark M, Hamady M, Cheshire NJ, Jenkins MP. Complex thoracoabdominal aortic aneurysms: endovascular exclusion with visceral revascularization. J Vasc Surg 2006; 43 (06) 1081-1089 , discussion 1089
    CrossrefPubMedGoogle Scholar
  • 16 Peterss S, Charilaou P, Ziganshin BA, Elefteriades JA. Assessment of survival in retrospective studies: the Social Security Death Index is not adequate for estimation. J Thorac Cardiovasc Surg 2017; 153 (04) 899-901
    CrossrefPubMedGoogle Scholar
  • 17 Bellomo R, Kellum JA, Ronco C. Defining and classifying acute renal failure: from advocacy to consensus and validation of the RIFLE criteria. Intensive Care Med 2007; 33 (03) 409-413
    CrossrefPubMedGoogle Scholar
  • 18 Elefteriades JA. Natural history of thoracic aortic aneurysms: indications for surgery, and surgical versus nonsurgical risks. Ann Thorac Surg 2002; 74 (05) S1877-S1880 , discussion S1892–S1898
    CrossrefPubMedGoogle Scholar
  • 19 Erbel R, Aboyans V, Boileau C. , et al; ESC Committee for Practice Guidelines; The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). 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. Eur Heart J 2014; 35 (41) 2873-2926
    CrossrefPubMedGoogle Scholar
  • 20 Liu LY, Callahan B, Peterss S. , et al. Neuromonitoring using motor and somatosensory evoked potentials in aortic surgery. J Card Surg 2016; 31 (06) 383-389
    CrossrefPubMedGoogle Scholar
  • 21 Goldstein LJ, Davies RR, Rizzo JA. , et al. Stroke in surgery of the thoracic aorta: incidence, impact, etiology, and prevention. J Thorac Cardiovasc Surg 2001; 122 (05) 935-945
    CrossrefPubMedGoogle Scholar
  • 22 Rizzo JA, Chen J, Fang H, Ziganshin BA, Elefteriades JA. Statistical challenges in identifying risk factors for aortic disease. Aorta (Stamford) 2014; 2 (02) 45-55
    Article in Thieme ConnectPubMedGoogle Scholar
  • 23 Coselli JS, LeMaire SA, Preventza O. , et al. Outcomes of 3309 thoracoabdominal aortic aneurysm repairs. J Thorac Cardiovasc Surg 2016; 151 (05) 1323-1337
    CrossrefPubMedGoogle Scholar
  • 24 Conrad MF, Crawford RS, Davison JK, Cambria RP. Thoracoabdominal aneurysm repair: a 20-year perspective. Ann Thorac Surg 2007; 83 (02) S856-S861 , discussion S890–S892
    CrossrefPubMedGoogle Scholar
  • 25 Svensson LG, Crawford ES, Hess KR, Coselli JS, Safi HJ. Experience with 1509 patients undergoing thoracoabdominal aortic operations. J Vasc Surg 1993; 17 (02) 357-368 , discussion 368–370
    CrossrefPubMedGoogle Scholar
  • 26 Safi HJ, Miller III CC, Huynh TT. , et al. Distal aortic perfusion and cerebrospinal fluid drainage for thoracoabdominal and descending thoracic aortic repair: ten years of organ protection. Ann Surg 2003; 238 (03) 372-380 , discussion 380–381
    CrossrefPubMedGoogle Scholar
  • 27 Epstein NE. Cerebrospinal fluid drains reduce risk of spinal cord injury for thoracic/thoracoabdominal aneurysm surgery: a review. Surg Neurol Int 2018; 9: 48
    CrossrefPubMedGoogle Scholar
  • 28 Tanaka H, Ogino H, Minatoya K. , et al; Japanese Study of Spinal Cord Protection in Descending and Thoracoabdominal Aortic Repair investigators. The impact of preoperative identification of the Adamkiewicz artery on descending and thoracoabdominal aortic repair. J Thorac Cardiovasc Surg 2016; 151 (01) 122-128
    CrossrefPubMedGoogle Scholar
  • 29 Estrera AL, Sandhu HK, Charlton-Ouw KM. , et al. A quarter century of organ protection in open thoracoabdominal repair. Ann Surg 2015; 262 (04) 660-668
    CrossrefPubMedGoogle Scholar
  • 30 Gaudino M, Lau C, Munjal M, Girardi LN. Open repair of ruptured descending thoracic and thoracoabdominal aortic aneurysms. J Thorac Cardiovasc Surg 2015; 150 (04) 814-821
    CrossrefPubMedGoogle Scholar
  • 31 Cowan Jr JA, Dimick JB, Henke PK, Huber TS, Stanley JC, Upchurch Jr GR. Surgical treatment of intact thoracoabdominal aortic aneurysms in the United States: hospital and surgeon volume-related outcomes. J Vasc Surg 2003; 37 (06) 1169-1174
    CrossrefPubMedGoogle Scholar
  • 32 Gopaldas RR, Huh J, Dao TK. , et al. Superior nationwide outcomes of endovascular versus open repair for isolated descending thoracic aortic aneurysm in 11,669 patients. J Thorac Cardiovasc Surg 2010; 140 (05) 1001-1010
    CrossrefPubMedGoogle Scholar
  • 33 Kouchoukos NT, Kulik A, Castner CF. Open thoracoabdominal aortic repair for chronic type B dissection. J Thorac Cardiovasc Surg 2015; 149 (2, Suppl) S125-S129
    CrossrefPubMedGoogle Scholar
  • 34 Kitagawa A, Greenberg RK, Eagleton MJ, Mastracci TM, Roselli EE. Fenestrated and branched endovascular aortic repair for chronic type B aortic dissection with thoracoabdominal aneurysms. J Vasc Surg 2013; 58 (03) 625-634
    CrossrefPubMedGoogle Scholar
  • 35 Nienaber CA, Rousseau H, Eggebrecht H. , et al; INSTEAD Trial. Randomized comparison of strategies for type B aortic dissection: the INvestigation of STEnt Grafts in Aortic Dissection (INSTEAD) trial. Circulation 2009; 120 (25) 2519-2528
    CrossrefPubMedGoogle Scholar
  • 36 Nienaber CA, Kische S, Rousseau H. , et al; INSTEAD-XL trial. 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 (04) 407-416
    CrossrefPubMedGoogle Scholar
  • 37 Thrumurthy SG, Karthikesalingam A, Patterson BO. , et al. A systematic review of mid-term outcomes of thoracic endovascular repair (TEVAR) of chronic type B aortic dissection. Eur J Vasc Endovasc Surg 2011; 42 (05) 632-647
    CrossrefPubMedGoogle Scholar
  • 38 Peterss S, Mansour AM, Ross JA. , et al. Changing pathology of the thoracic aorta from acute to chronic dissection: literature review and insights. J Am Coll Cardiol 2016; 68 (10) 1054-1065
    CrossrefPubMedGoogle Scholar
  • 39 Canaud L, Karthikesalingam A, Jackson D. , et al. Clinical outcomes of single versus staged hybrid repair for thoracoabdominal aortic aneurysm. J Vasc Surg 2013; 58 (05) 1192-1200
    CrossrefPubMedGoogle Scholar
  • 40 Chiesa R, Tshomba Y, Melissano G, Logaldo D. Is hybrid procedure the best treatment option for thoraco-abdominal aortic aneurysm?. Eur J Vasc Endovasc Surg 2009; 38 (01) 26-34
    CrossrefPubMedGoogle Scholar