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General Thoracic and Cardiovascular Surgery

, Volume 67, Issue 1, pp 168–174 | Cite as

Reflection of pioneers: redo thoracoabdominal aortic aneurysm repair controversies in thoracic aortic aneurysm surgery

  • Joseph S. CoselliEmail author
SPECIAL EDITION Controversies in Surgery for Thoracic Aorta

Abstract

Reoperative thoracoabdominal aortic aneurysm repair is frequently necessary and brings with it a unique set of challenges. Typically, most reoperative repairs are necessitated by aortic disease progressing into previously healthy aortic tissue from a replaced section of the aorta (an extension of the previous repair) or, to a lesser degree, because of a late complication of prior distal aortic repair (an open or endovascular repair failure). Characterizing the reason for the reoperation as well as the location of prior repair is the first step towards anticipating major outcomes following such repair. Since the introduction of endovascular repair for aortic aneurysms, indications for open repair have become more specific and limited; many centers have justified using endovascular approaches in patients with prior open aortic repair by deeming these patients “high risk” because of their previous incision. Our analysis found that reoperative repairs were not typically subject to worse early outcomes than patients without prior distal aortic repair, except for the more complicated types of reoperation, which involve infection.

Keywords

Thoracoabdominal aortic aneurysm repair Reoperation Aortic aneurysm Descending thoracic aorta Abdominal aorta Open surgical repair Thoracic endovascular aortic repair 

Notes

Acknowledgements

Dr. Coselli thanks Susan Y. Green, MPH, and Hiruni S. Amarasekara, MS, for editorial support, and Scott A. Weldon, MA, CMI, and Nathan Gray, BFA for creating the illustrations.

Funding

None.

Compliance with ethical standards

Conflict of interest

The author declares that they have no competing interest.

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Copyright information

© The Japanese Association for Thoracic Surgery 2018

Authors and Affiliations

  1. 1.Division of Cardiothoracic Surgery, Michael E. DeBakey Department of SurgeryBaylor College of MedicineHoustonUSA
  2. 2.Section of Adult Cardiac Surgery, Department of Cardiovascular SurgeryTexas Heart InstituteHoustonUSA
  3. 3.CHI St. Luke’s Health-Baylor St. Luke’s Medical CenterHoustonUSA

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