Open surgical therapy of thoracoabdominal aortic aneurysms and chronic expanding aortic dissections: analysis of perioperative prognostic factors

摘要

AIM OF THE STUDY: The aim of the study was to investigate perioperative prognostic factors and long-term outcome following conventional open repair (COR) of thoracoabdominal aortic aneurysms (TAAA) and chronic expanding aortic dissections (CEAD). PATIENTS AND METHODS: Between March 1993 and December 2005, 92 patients underwent elective COR for TAAA or CEAD in our institution. Passive distal aortic perfusion during cross-clamping was used in 36 patients (39%). Medical records and imaging studies of all patients were reviewed. Follow-up included history, physical examination and CT or MR angiography. Median follow-up was 40 months (range 1-139 months). RESULTS: Intraoperative, 30-day and in-hospital mortality rates were 2%, 8% and 12%, respectively. The estimated survival rate after 5 years was 70% and 43% of all deaths were cardiac related. The paraplegia rate was 10%, the rate of patients developing chronic renal failure requiring hemodialysis was 3% and 21% of patients required surgical revision. In multivariate analyses the need for surgical revision (OR: 8.465; CI: 0.802-89.318; p=0.024) and postoperative elevated serum transaminase values (OR: 1.009; CI: 1.002-1.017; p=0.017) independently predicted 30-day mortality. Peripheral arterial disease (OR: 4.41; CI:1.672-11.611; p=0.003), intraoperative complications such as disseminated intravasal coagulation and asystole (OR: 4.28; CI: 1.128-16.267; p=0.033), postoperative elevated bilirubin values >2.5 mg/dl (OR: 1.06; CI: 1.009-1.112; p=0.019), and postoperative ventilation >7 days (OR: 7.79; CI: 2.499-24.246; p<0,0001) independently predicted long-term mortality. CONCLUSION: Postoperative elevated liver values represent negative prognostic factors and may indicate a more standardized use of active shunt systems for organ perfusion.