Perioperative Outcomes of Repeated Open Surgery on the Thoracic Aorta
ackground: Repeated thoracic aorta repair is increasingly common. With the increase in hybrid procedures, determination of the best treatment strategy requires evaluation of the clinical outcomes of classic open surgery.
Methods: We retrospectively reviewed 119 patients
(84 men and 35 women, aged 51.0 ± 16.7 years) with a history of open repair involving the thoracic aorta above the diaphragm. The patients underwent an average of 1.3 ± 0.8 surgeries (range: 1-8) on the thoracic aorta before the final operation. Clinical outcomes were evaluated on the basis of the need for emergency surgery, indications for surgery, pathologic causes, and other operative variables.
Results: Hospital mortality was 6.7% (n = 8). Postoperative bleeding occurred in 16% (n = 19). On multivariable analysis, emergency surgery (odds ratio [OR], 19.005; P = .003; 95% confidence interval [CI], 2.710-133.305) and cardiopulmonary bypass (CPB) time (OR, 1.562 per 30 minutes; P = .007;
95% CI, 1.126-2.165) were predictors of hospital death. Emergency surgery (OR, 4.105; P = .029; 95% CI, 1.157-14.567) and CPB time (OR, 1.189 per 30 minutes; P = .035; 95% CI, 1.012-1.396) were also associated with postoperative bleeding, in addition to surgery for an infectious cause (OR, 10.824; P = .010; 95% CI, 1.755-66.770). Estimated survival at 1, 5, and 7 years was 86.6%, 80.5%, and 78.2%, respectively.
Conclusion: Despite the variety of preoperative conditions and operations performed, repeated open surgery for thoracic aorta repair can be performed with acceptable early and late outcomes.
Afifi RO, Sandhu HK, Trott AE, et al. 2017. Redo thoracoabdominal aortic aneurysm repair: a single-center experience over 25 years. Ann Thorac Surg 103:1421-28.
Bickerstaff LK, Pairolero PC, Hollier LH, et al. 1982. Thoracic aortic aneurysms: a population-based study. Surgery 92:1103-8.
Carrel T, Pasic M, Jenni R, Tkebuchava T, Turina MI. 1993. Reoperations after operation on the thoracic aorta: etiology, surgical techniques, and prevention. Ann Thorac Surg 56:259-68; discussion 269.
Chiesa R, Bertoglio L, Kahlberg A, Rinaldi E, Tshomba Y, Melissano G. 2014. Redo surgery in ascending aorta and aortic arch. J Cardiovasc Surg (Torino) 55:803-12.
Chong BK, Jung SH, Choo SJ, Chung CH, Lee JW, Kim JB. 2016. Reoperative aortic root replacement in patients with previous aortic root or aortic valve procedures. Korean J Thorac Cardiovasc Surg 49:250-7.
Coselli JS, Rosu C, Amarasekara HS, et al. 2018. Reoperative surgery on the thoracoabdominal aorta. J Thorac Cardiovasc Surg 155:474-85.e1.
Crawford ES, Cohen ES. 1982. Aortic aneurysm: a multifocal disease: Presidential address. Arch Surg 117:1393-400.
Di Bartolomeo R, Berretta P, Pantaleo A, et al. 2017. Long-term outcomes of open arch repair after a prior aortic operation: our experience in 154 patients. Ann Thorac Surg 103:1406-12.
Di Bartolomeo R, Berretta P, Petridis FD, et al. 2013. Reoperative surgery on the thoracic aorta. J Thorac Cardiovasc Surg 145:S78-84.
Etz CD, Zoli S, Kari FA, et al. 2009. Redo lateral thoracotomy for reoperative descending and thoracoabdominal aortic repair: a consecutive series of 60 patients. Ann Thorac Surg 88:758-66; discussion 767.
Gallitto E, Gargiulo M, Freyrie A, et al. 2016. Fenestrated and branched endograft after previous aortic repair. Ann Vasc Surg 32:119-27.
Georgiadis GS, van Herwaarden JA, Saengprakai W, et al. 2017. Endovascular treatment of complex abdominal and thoracoabdominal type IV aortic aneurysms with fenestrated technology. J Cardiovasc Surg (Torino) 58:574-90.
Johnston WF, Upchurch GR Jr, Tracci MC, Cherry KJ, Ailawadi G, Kern JA. 2012. Staged hybrid approach using proximal thoracic endovascular aneurysm repair and distal open repair for the treatment of extensive thoracoabdominal aortic aneurysms. J Vasc Surg 56:1495-502.
Mendes BC, Oderich GS. 2016. Endovascular repair of thoracoabdominal aortic aneurysm using the off-the-shelf multibranched t-Branch stent graft. J Vasc Surg 63:1394-99.e2.
Muhs BE, Verhoeven EL, Zeebregts CJ, et al. 2006. Mid-term results of endovascular aneurysm repair with branched and fenestrated endografts. J Vasc Surg 44:9-15.
Preventza O, Garcia A, Cooley DA, et al. 2014. Reoperations on the total aortic arch in 119 patients: short- and mid-term outcomes, focusing on composite adverse outcomes and survival analysis. J Thorac Cardiovasc Surg 148:2967-72.
Quintana E, Bajona P, Schaff HV, et al. 2014. Open aortic arch reconstruction after previous cardiac surgery: outcomes of 168 consecutive operations. J Thorac Cardiovasc Surg 148:2944-50.
Roselli EE, Greenberg RK, Pfaff K, Francis C, Svensson LG, Lytle BW. 2007. Endovascular treatment of thoracoabdominal aortic aneurysms. J Thorac Cardiovasc Surg 133:1474-82.
Rosset E, Ben Ahmed S, Galvaing G, et al. 2014. Editor’s choice – hybrid treatment of thoracic, thoracoabdominal, and abdominal aortic aneurysms: a multicenter retrospective study. Eur J Vasc Endovasc Surg 47:470-8.
Stasek J, Polansky P, Bis J, et al. 2008. The percutaneous closure of a large pseudoaneurysm of the ascending aorta with an atrial septal defect Amplatzer occluder: two-year follow-up. Can J Cardiol 24:e99-101.
Svensson LG, Crawford ES, Hess KR, Coselli JS, Safi HJ. 1993. Experience with 1509 patients undergoing thoracoabdominal aortic operations. J Vasc Surg 17:357-68; discussion 368-70.
Verhoeven EL, Katsargyris A, Bekkema F, et al. 2015. Editor’s Choice – ten-year experience with endovascular repair of thoracoabdominal aortic aneurysms: results from 166 consecutive patients. Eur J Vasc Endovasc Surg 49:524-31.
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