Pulmonary Complications Adversely Affect Long-term Mortality Following Descending and Thoracoabdominal Aneurysm Repair
Konstadinos Plestis, Oleg Orlov, Carlos Padula, Mostafa Sadek, Li Zhang, Lankenau Medical Center, Philadelphia, PA
OBJECTIVE: Pulmonary complications are common following the repair of descending thoracic aortic aneurysm (DTAA) and thoracoabdominal aortic aneurysm (TAAA), respectively. This study aimed to determine the effects of postoperative pulmonary complications on the surgical outcomes.
METHODS: Retrospective medical records review was conducted in patients underwent DTAA or TAAA repair between 1998- 2011. The two indexes, including 1) the prolonged ( ‰¥48 hours) ventilatory support (PVS), and 2) tracheostomy were used as the measures of clinical outcomes.
RESULTS: There were 206 patients (age 63 ±12 years, 61.7% male) with 148 (71.8%) underwent TAAA and 58 (28.2%) DTAA repairs. Post operative pulmonary complications developed in 102 patients (49.5%). PVS was necessary in 88 (42.7%), and tracheostomy in 24 (11.7%) patients. The 30-day mortality rate was 8.3% whereas the long term mortality was 29.2% with a mean follow-up of 5.5 ±3.5 years. PVS was a univariate predictor of long-term mortality (p<0.01), and tracheostomy was a univariate predictor of in-hospital mortality (p<0.01). Seven year survival rate for patients requiring PVS vs. those who did not was 50% vs.75% (p<0.001). Seven year survival for patients with tracheostomy vs. those without was 38% vs. 68% (p<0.0001)
CONCLUSION: Tracheostomy was a significant predictor of short and long-term mortality. PVS was a significant predictor of long-term mortality. These complications adversely affected the long-term survival of patients after DTAA and TAAA repair.