Eastern Cardiothoracic Surgical Society

Operative Outcomes After Open Repair of Descending Thoracic Aortic Aneurysms in the Era of Endovascular Surgery
Mostafa Sadek, Djamila Abjigitova, Yonni Pellet, Aditya Rachakonda, Georgia Panagopoulos, Konstadinos Plestis, Lenox Hill Hospital, New York, NY

OBJECTIVE: Since the advent of endovascular repair of descending thoracic aortic aneurysms (DTAA), there has been a paucity of open repairs data. This study details operative and long term outcomes in a contemporary series of open DTAA repairs.

METHODS: We conducted a retrospective review of prospectively collected data of 68 patients (63 14.5 years) who underwent DTAA repairs between (January-1999) and (December-2010).

RESULTS: Forty-two (62%) patients were male, 16 (24%) had chronic obstructive pulmonary disease, 11 (16%) contained rupture, 25 (37%) previous cardio-aortic surgery, and 10 (15%) had previous aortic arch replacement. Cardiopulmonary bypass was used in 64 (94%) and deep hypothermic arrest in 22 (32%). In-hospital mortality was 3% (2 patients). There was no immediate paraplegia, and one (1.5%) delayed paraplegia. Three (4.4%) patients experienced a postoperative stroke, and 20 (29%) required prolonged ventilatory support ( 48 hours). Six (9%) patients developed postoperative new onset renal insufficiency (creatinine 2.5 mg/dL). The median follow-up time was 5.8 3.8 years. Sixteen patients (24.2%) of the 66 operative survivors died during follow-up. Probability of survival was 82 0.05% at 5 and 67 0.07% at 10 years. Reintervention was necessary in 4 (6%) patients. Freedom from reintervention was 98 0.02% at 5 and 89 0.06% at 10 years. Univariable predictors of long term mortality was postoperative reintubation (P<.05).

CONCLUSIONS: In the era of endovascular repair of DTAAs, operative mortality and morbidity outcomes for open repairs are observed to be low. In addition to good long term survival rates, the open repairs are durable as evidenced by low reintervention rates.