Abstract
In the last few years, advances in surgical techniques and in organ protection adjuncts have improved outcomes in thoracic (TAA) and thoracoabdominal aortic aneurysm (TAAA) surgical repair, although mortality and morbidity are still noteworthy. The aim of the current retrospective study is to determine whether the use of adjuncts influenced mortality and morbidity rates. From 1993 to 2003 we performed 353 procedures for TAA (175 cases) and TAAA (178 cases). This series has been divided into two consecutive groups: in group I (from 1993 to 1997), distal aortic perfusion with left atriofemoral bypass and cerebrospinal fluid drainage were used selectively, and in group II (from 1998 to 2003), the adjuncts were used routinely (together with surgical techniques of less invasive approach in selected cases). Total in-hospital mortality rates were significantly different (p < 0.05): 15.9% in group I and 8.6% in group II. The overall incidence of paraplegia or paraparesis in group I was 8.3% and in Group II it was 5.1%. Renal failure occurred in 9.6% of group I and in 4.1% of group II. The incidence of respiratory failure in group I was 28%, and was 17.9% in group II. Respiratory failure was significantly lower (p < 0.05) in group II. The reduction in the incidence of renal failure and paraplegia in the two groups was nonsignificant. In conclusion, the use of adjuncts and our improved experience allowed us to achieve a significant improvement in mortality and major morbidity rates in the group of patients operated on after 1998.
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References
JS Coselli LD Conklin SA LeMaire (2002) ArticleTitleThoracoabdominal aortic aneurysm repair: review and update of current strategies Ann. Thorac. Surg. 74 1881–1884 Occurrence Handle10.1016/S0003-4975(02)04139-5
SA LeMaire CC Miller SuffixIII LD Conklin et al. (2003) ArticleTitleEstimating group mortality and paraplegia rates after thoracoabdominal aortic aneurysm repair Ann. Thorac. Surg. 75 508–513 Occurrence Handle10.1016/S0003-4975(02)04347-3 Occurrence Handle12607663
VS Kashyap RP Cambria JK Davison et al. (1997) ArticleTitleRenal failure after thoracoabdominal aortic surgery J. Vasc. Surg. 26 949–955 Occurrence Handle1:STN:280:DyaK1c%2FosFOqtQ%3D%3D Occurrence Handle9423709
HJ Safi SA Harlin CC Miller et al. (1996) ArticleTitlePredictive factors for acute renal failure in thoracic and thoracoabdominal aortic aneurysm surgery J. Vasc. Surg. 24 338–344 Occurrence Handle1:STN:280:BymH3cvotFA%3D Occurrence Handle8808955
SR Money K Rice D Crockett et al. (1994) ArticleTitleRisk of respiratory failure after repair of thoracoabdominal aortic aneurysms Am. J. Surg. 168 152–155 Occurrence Handle1:STN:280:ByuA3s%2FltlI%3D Occurrence Handle8053516
M Fagevik Olsen E Wennberg E Johnsson et al. (2002) ArticleTitleRandomized clinical study of the prevention of pulmonary complications after thoracoabdominal resection by two different breathing techniques Br. J. Surg. 89 1228–1234 Occurrence Handle10.1046/j.1365-2168.2002.02207.x Occurrence Handle1:STN:280:DC%2BD38vos1Crug%3D%3D Occurrence Handle12296888
MJ Brooks J Mayet B Glenville et al. (2001) ArticleTitleCardiac investigation and intervention prior to thoraco-abdominal aneurysm repair: coronary angiography in 35 patients Eur. J. Vasc. Endovasc. Surg. 21 437–444 Occurrence Handle10.1053/ejvs.2001.1310 Occurrence Handle1:STN:280:DC%2BD3M3lsVOjug%3D%3D Occurrence Handle11352520
DA Bigatel DP Franklin JR Elmore et al. (1999) ArticleTitleDobutamine stress echocardiography prior to aortic surgery: long-term cardiac outcome Ann. Vasc. Surg. 13 17–22 Occurrence Handle10.1007/s100169900215 Occurrence Handle1:STN:280:DyaK1M%2Fps1GmsA%3D%3D Occurrence Handle9878652
R Chiesa G Melissano AM Jannello et al. (2002) ArticleTitleSurgical treatment of thoracic and thoracoabdominal aortic aneurysms: experience with left atriofemoral bypass G. Ital. Chir. Vasc. 9 81–100
HJ Safi (1999) ArticleTitleHow I do it: thoracoabdominal aortic aneurysm graft replacement Cardiovasc. Surg. 7 607–613 Occurrence Handle10.1016/S0967-2109(99)00039-3 Occurrence Handle1:STN:280:DyaK1MvkslWmtQ%3D%3D Occurrence Handle10519668
J Engle HJ Safi CC Miller SuffixIII et al. (1999) ArticleTitleThe impact of diaphragm management on prolonged ventilator support after thoracoabdominal aortic repair J. Vasc. Surg. 29 150–156 Occurrence Handle1:STN:280:DyaK1M7gt1artg%3D%3D Occurrence Handle9882799
GL Gilling-Smith JH Wolfe (1995) ArticleTitleTransabdominal repair of type IV thoracoabdominal aortic aneurysms Eur. J. Vasc. Endovasc. Surg. 9 112–113 Occurrence Handle1:STN:280:ByqA1MzhtVQ%3D Occurrence Handle7663998
MJ Brooks A Bradbury HN Wolfe (1999) ArticleTitleElective repair of type IV thoracoabdominal aortic aneurysms; experience of a subcostal (transabdominal) approach Eur. J. Vasc. Endovasc. Surg 18 290–293 Occurrence Handle10.1053/ejvs.1999.0830 Occurrence Handle1:STN:280:DC%2BD3c%2FitVKjsQ%3D%3D Occurrence Handle10550262
MJ Jacobs L Eijsman SA Meylaerts et al. (1998) ArticleTitleReduced renal failure following thoracoabdominal aortic aneurysm repair by selective perfusion Eur. J. Cardiothorac. Surg. 14 201–205 Occurrence Handle10.1016/S1010-7940(98)00164-X Occurrence Handle1:STN:280:DyaK1cvis1SjsQ%3D%3D Occurrence Handle9755008
HJ Safi CC Miller SuffixIII C Carr et al. (1998) ArticleTitleImportance of intercostal artery reattachment during thoracoabdominal aortic aneurysm repair J. Vasc. Surg. 27 58–66 Occurrence Handle1:STN:280:DyaK1c7jsVemug%3D%3D Occurrence Handle9474083
C Koksoy SA LeMaire PE Curling et al. (2002) ArticleTitleRenal perfusion during thoracoabdominal aortic operations: cold crystalloid is superior to normothermic blood Ann. Thorac. Surg. 73 730–738 Occurrence Handle10.1016/S0003-4975(01)03575-5 Occurrence Handle11899174
RP Cambria WD Clouse JK Davison et al. (2002) ArticleTitleThoracoabdominal aneurysm repair: results with 337 operations performed over a 15-year interval Ann. Surg. 236 471–479 Occurrence Handle10.1097/00000658-200210000-00010 Occurrence Handle12368676
MD Dake DC Miller CP Semba et al. (1994) ArticleTitleTransluminal placement of endovascular stent-grafts for the treatment of descending thoracic aortic aneurysms N. Eng. J. Med. 331 1729–1734 Occurrence Handle10.1056/NEJM199412293312601 Occurrence Handle1:STN:280:ByqD2srktVA%3D
M Ehrlich M Grabenwöger F Cartes-Zumelzu et al. (1998) ArticleTitleEndovascular stent-graft repair for aneurysms on the descending thoracic aorta Ann. Thorac. Surg. 66 19–25 Occurrence Handle10.1016/S0003-4975(98)00390-7 Occurrence Handle1:STN:280:DyaK1czlsFWlsw%3D%3D Occurrence Handle9692433
R Greenberg T Resch U Nyman et al. (2000) ArticleTitleEndovascular repair of descending thoracic aortic aneurysms: an early experience with intermediate-term follow-up J. Vasc. Surg. 31 147–156 Occurrence Handle1:STN:280:DC%2BD3c7htFensQ%3D%3D Occurrence Handle10642717
T Temudom M D’Ayala M Marin et al. (2000) ArticleTitleEndovascular grafts in the treatment of thoracic aortic aneurysms and pseudoaneurysms Ann. Vasc. Surg. 14 230–238 Occurrence Handle10.1007/s100169910040 Occurrence Handle1:STN:280:DC%2BD3c3ls1Oqtg%3D%3D Occurrence Handle10796954
RH Heijmen IG Deblier FL Moll et al. (2002) ArticleTitleEndovascular stent-grafting for descending thoracic aortic aneurysms Eur. J. Cardiothorac. Surg. 21 5–9 Occurrence Handle10.1016/S1010-7940(01)01075-2 Occurrence Handle11788247
S Najibi TT Terramani VJ Weiss et al. (2002) ArticleTitleEndoluminal versus open treatment of descending thoracic aortic aneurysms J. Vasc. Surg. 36 732–737 Occurrence Handle10.1016/S0741-5214(02)00126-X Occurrence Handle12368734
J Bleyn F Schol I Vanhandenhove et al. (2002) ArticleTitleSide-branched modular endograft system for thoracoabdominal aortic aneurysm repair J. Endovasc. Ther. 9 838–841 Occurrence Handle10.1583/1545-1550(2002)009<0838:SBMESF>2.0.CO;2 Occurrence Handle12546586
JH Palma F Miranda AR Gasques et al. (2002) ArticleTitleTreatment of thoracoabdominal aneurysm with self-expandable aortic stent grafts Ann. Thorac. Surg. 74 1685–1687 Occurrence Handle10.1016/S0003-4975(02)04028-6 Occurrence Handle12440631
T Ohata S Fukuda I Kigawa et al. (1998) ArticleTitleLimitation of implantation of endovascular stent-graft: case report of a patient with thoracoabdominal aneurysm J. Thorac. Cardiovasc. Surg. 116 876–877 Occurrence Handle1:STN:280:DyaK1M%2FitFagtg%3D%3D Occurrence Handle9806397
RP Cambria JK Davison S Zannetti et al. (1997) ArticleTitleThoracoabdominal aneurysm repair: perspectives over a decade with the clamp-and-sew technique Ann. Surg. 226 294–303 Occurrence Handle10.1097/00000658-199709000-00009 Occurrence Handle1:STN:280:ByiH2sbosFE%3D Occurrence Handle9339936
MA Schepens FE Vermeulen WJ Morshuis et al. (1999) ArticleTitleImpact of left heart bypass on the results of thoracoabdominal aortic aneurysm repair Ann. Thorac. Surg 67 1963–1967 Occurrence Handle10.1016/S0003-4975(99)00391-4 Occurrence Handle1:STN:280:DyaK1MzhvVagsA%3D%3D Occurrence Handle10391348
A Azizzadeh TT Huynh CC Miller SuffixIII et al. (2003) ArticleTitlePostoperative risk factors for delayed neurologic deficit after thoracic and thoracoabdominal aortic aneurysm repair: a case-control study J. Vasc. Surg. 37 750–754 Occurrence Handle10.1067/mva.2003.211 Occurrence Handle12663973
LG Svensson ES Crawford KR Hess et al. (1992) ArticleTitleThoracoabdominal aortic aneurysms associated with celiac, superior mesenteric, and renal artery occlusive disease: methods and analysis of results in 271 patients J. Vasc. Surg. 16 378–390 Occurrence Handle10.1067/mva.1992.38646 Occurrence Handle1:STN:280:By2A1MrntF0%3D Occurrence Handle1522640
LG Svensson ES Crawford KR Hess et al. (1993) ArticleTitleExperience with 1509 patients undergoing thoracoabdominal aortic operations J. Vasc. Surg. 17 357–368 Occurrence Handle10.1067/mva.1993.42297 Occurrence Handle1:STN:280:ByyC28vjt1w%3D Occurrence Handle8433431
LG Svensson JS Coselli HJ Safi et al. (1989) ArticleTitleAppraisal of adjuncts to prevent acute renal failure after surgery on the thoracic or thoracoabdominal aorta J. Vasc. Surg. 10 230–239 Occurrence Handle10.1067/mva.1989.13947 Occurrence Handle1:STN:280:BiaA1c3otVc%3D Occurrence Handle2778885
MJ Hanley K Davidson (1981) ArticleTitlePrior mannitol and furosemide infusion in a model of ischemic acute renal failure Am. J. Physiol. 241 556–564
JE Rectenwald TS Huber TD Martin et al. (2002) ArticleTitleFunctional outcome after thoracoabdominal aortic aneurysm repair J. Vasc. Surg. 35 640–647 Occurrence Handle10.1067/mva.2002.119238 Occurrence Handle11932656
MA Schepens JJ Defauw RP Hamerlijnck et al. (1994) ArticleTitleSurgical treatment of thoracoabdominal aortic aneurysms by single crossclamping: risk factors and late results J. Thorac. Cardiovasc. Surg. 107 134–142 Occurrence Handle1:STN:280:ByuC3M7ls10%3D Occurrence Handle8283876
JS Coselli (1992) ArticleTitlePerioperative management: patient selection, patient work-up, operative management, and postoperative management Semin. Vasc. Surg. 5 146–156
LG Svensson KR Hess JS Coselli et al. (1991) ArticleTitleA prospective study of respiratory failure after high-risk surgery on the thoracoabdominal aorta J. Vasc. Surg. 14 271–282 Occurrence Handle10.1067/mva.1991.30624 Occurrence Handle1:STN:280:By6A2M%2Fit1M%3D Occurrence Handle1880835
MA Golden MC Donaldson AD Whittemore et al. (1991) ArticleTitleEvolving experience with thoracoabdominal aortic aneurysm repair at a single institution J. Vasc. Surg. 13 792–796 Occurrence Handle10.1067/mva.1991.28563 Occurrence Handle1:STN:280:By6B2crmt10%3D Occurrence Handle2038102
TTT Huynh CC Miller SuffixIII AL Estrera et al. (2002) ArticleTitleDeterminants of hospital length of stay after thoracoabdominal aortic aneurysm repair J. Vasc. Surg. 35 648–653 Occurrence Handle10.1067/mva.2002.121566 Occurrence Handle1:STN:280:DC%2BD387pvFOhsg%3D%3D Occurrence Handle11932657
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Presented at the Eighteenth Annual Meeting of the Société de Chirurgie Vasculaire de Langue Française, Toulouse, France, May 21-24, 2003.
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Chiesa, R., Melissano, G., Civilini, E. et al. Ten Years Experience of Thoracic and Thoracoabdominal Aortic Aneurysm Surgical Repair: Lessons Learned. Ann Vasc Surg 18, 514–520 (2004). https://doi.org/10.1007/s10016-004-0072-z
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DOI: https://doi.org/10.1007/s10016-004-0072-z