Eastern Cardiothoracic Surgical Society

Short and Long-Term Outcomes of Thoracoabdominal Aortic Aneurysm Repair in Chronic Type B Aortic Dissection compared to Atherosclerotic Aneurysm
Georgia Panagopoulos, Oleg I. Orlov, Kristen Lee, Cinthia P. Orlov, Vishal N. Shah, Manabu Takebe, Matthew Thomas, Konstadinos A. Plestis, Lankenau Medical Center, Wynnewood, PA


OBJECTIVE: Open surgical repair (OSR) for thoracoabdominal aortic aneurysm (TAAA) may result in different rates of morbidity and mortality, depending on patient characteristics associated with specific diagnostic subgroups. In this study, we tried to determine whether patient-level variables and surgical outcomes are similar in the following two TAAA diagnostic subgroups: the chronic type B aortic dissection (CTBAD) and the atherosclerotic aneurysm (AA) groups.

METHODS: From 1999 to 2017, a total of 221 patients had repair of the descending and thoracoabdominal aortic aneurysms. There were 107 (18.6% descending and 81.4% TAA aneurysms) in the CTBAD Group and 113 (38.3% descending and 61.7% TAA aneurysms) patients in the AA Group.

RESULTS: There were more male CTBAD patients who were younger, had a history of dialysis, a diagnosis of Marfan's syndrome and previous ascending and stage 1 elephant trunk procedures. AA patients tended to be older (12 years on average), and smokers with a history of diabetes, COPD, CABG and AAA. Postoperative outcomes were similar in both groups, except for vocal cord paralysis which occurred more frequently in CTBAD patients. A significantly smaller percentage of AA than CTBAD patients were alive at long-term follow-up (48% vs 65%, respectively, p=.02). Table 1 presents the demographic and perioperative characteristics for both groups.

CONCLUSIONS: Although our results show that CTBAD patients differ from AA patients on a number of demographic and clinical characteristics, both groups seem to follow a similar postoperative course. Nevertheless, long-term follow-up suggests that CTBAD patients fare better with OSR than AA patients.


Table 1. Atherosclerosis vs. CTBAD in patients with TAAA Repair

Variable Atherosclerosis

(n=113)

Dissection

(n= 107)

p Value
Preoperative characteristics
Age** 69 10 57 10 0.000
Male (% 61 (54) 76 (71) 0.012
Marfan (% 0 13 (12.1) 0.000
Elephant Trunk Stage 1 (%) 4 (3.5) 19 (17.8) 0.001
Post-operative outcomes
Renal Insufficiency (%) 13 (11.5) 10 (9.3) 0.781
Delayed paraplegia (%) 1 (0.8) 1 (0.8) 1
Vocal cord paralysis (%) 10 (8.8) 20 (18.7) 0.048
Reoperation for bleeding (%) 8 (7.1) 9 (8.4) 0.803
Hospital mortality (%) 13 (11.5) 5 (4) 0.085
Long-term mortality (%) 58 (51.3 38 (35.5) 0.020
Values are expressed as n (%)

*Median

** Mean SD