Outcomes following Management of Complex Thoracoabdominal Aneurysm by an Open Approach
Abstract
:1. Introduction
2. Materials and Methods
2.1. Patients
2.2. Patient Evaluation, Imaging and Preoperative Adjuncts
2.3. Patient Preparation, Surgical Technique, Intra- and Postoperative Adjuncts
2.4. Outcomes
2.5. Statistical Analysis
3. Results
4. Discussion
5. Limitations
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Group 1 (455 pts) | Group 2 (652 pts) | p | Total (1107 pts) | |
---|---|---|---|---|
Preoperative characteristics | ||||
Age, years | 71.3 (+6.5) | 72.1 (+7.2) | 0.653 | 71.8 (+7.0) |
Male sex | 337 (74.1) | 497 (76.2) | 0.411 | 834 (75.3) |
Hypertension | 286 (62.8) | 434 (66.6) | 0.203 | 720 (65.0) |
History of smoking | 223 (49.0) | 274 (42.0) | 0.021 | 497 (44.9) |
Diabetes | 72 (15.8) | 87 (13.3) | 0.246 | 159 (14.4) |
Dyslipidemia | 191 (42.0) | 265 (40.6) | 0.657 | 456 (41.2) |
History of coronary artery disease | 114 (25.1) | 176 (27.0) | 0.470 | 290 (26.2) |
Cerebrovascular disease | 34 (7.5) | 33 (5.1) | 0.097 | 67 (6.1) |
Chronic obstructive pulmonary disease | 55 (12.1) | 68 (10.4) | 0.387 | 123 (11.1) |
Chronic renal failure | 167 (36.7) | 253 (38.8) | 0.478 | 420 (37.9) |
Aneurysm diameter, mm | 64 (+7) | 67 (+11) | 0.223 | 66 (+9) |
Previous aortic surgery | 37 (8.1) | 79 (12.1) | 0.033 | 116 (10.5) |
Extension | ||||
TAAA extent I | 93 (20.4) | 137 (21.0) | 0.817 | 230 (20.8) |
TAAA extent II | 127 (27.9) | 191 (29.3) | 0.616 | 318 (28.7) |
TAAA extent III | 141 (31.0) | 206 (31.6) | 0.830 | 347 (31.3) |
TAAA extent IV | 94 (20.7) | 118 (18.1) | 0.286 | 212 (19.2) |
Etiology | ||||
Degenerative | 328 (72.1) | 458 (70.2) | 0.506 | 786 (71.0) |
Dissection | 96 (21.1) | 155 (23.8) | 0.295 | 251 (22.7) |
Other | 31 (6.8) | 39 (6.0) | 0.575 | 70 (6.3) |
Group 1 (455 pts) | Group 2 (652 pts) | p | |
---|---|---|---|
Intraoperative details | |||
CSFD | 204 (44.8%) | 566 (86.8%) | <0.001 |
TEE | 12 (2.6%) | 617 (94.6%) | <0.001 |
MEP&SSEP | 7 (1.5) | 547 (84.0%) | <0.001 |
Procedural time, minutes | 258 (201–390) | 231 (198–377) | 0.063 |
LHBP | 371 (81.5%) | 578 (88.7 %) | <0.001 |
Proximal clamping | |||
Between LCCA and LSA | 26 (5.7%) | 109 (16.7%) | <0.001 |
Distally to the origin of the LSA | 277 (60.9%) | 341 (52.3%) | 0.005 |
DTA mid/distal portion | 152 (33.4%) | 202 (31.0%) | 0.394 |
Intercostal artery reattachment | 217 (47.7%) | 351 (53.8%) | 0.044 |
Visceral artery reattachment | |||
Carrell patch 4-vessels (or beveled) | 261 (57.4%) | 156 (23.9%) | <0.001 |
Carrell patch (or beveled) + selective bypass | 133 (29.2%) | 389 (59.7%) | <0.001 |
Selective bypasses | 61 (13.4%) | 107 (16.4%) | 0.170 |
Renal artery perfusion with HTK solution | 73 (16.0%) | 557 (85.4%) | <0.001 |
Use of ROTEM | 0 | 198 (30.4%) | <0.001 |
Group 1 (455 pts) n (%) | Group 2 (652 pts) n (%) | p | Total (1107 pts) n (%) | |
---|---|---|---|---|
Perioperative results | ||||
30-day mortality | 61 (13.4) | 53 (8.1) | 0.004 | 114 (10.3) |
Respiratory failure | 145 (31.9) | 177 (27.1) | 0.088 | 322 (29.1) |
Permanent SCI | 54 (11.9) | 51 (7.8) | 0.023 | 105 (9.5) |
Renal failure | 33 (7.2) | 31 (4.7) | 0.079 | 64 (5.8) |
Myocardial ischemia | 12 (2.6) | 9 (1.4) | 0.131 | 21 (2.0) |
Stroke | 5 (1.1) | 8 (1.2) | 0.845 | 13 (1.2) |
Mesenteric ischemia | 13 (2.9) | 14 (2.2) | 0.451 | 27 (2.4) |
Need for re-intervention | 35 (7.7) | 39 (6.0) | 0.262 | 74 (6.7) |
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Chiesa, R.; Rinaldi, E.; Kahlberg, A.; Tinaglia, S.; Santoro, A.; Colacchio, G.; Melissano, G. Outcomes following Management of Complex Thoracoabdominal Aneurysm by an Open Approach. J. Clin. Med. 2023, 12, 3193. https://doi.org/10.3390/jcm12093193
Chiesa R, Rinaldi E, Kahlberg A, Tinaglia S, Santoro A, Colacchio G, Melissano G. Outcomes following Management of Complex Thoracoabdominal Aneurysm by an Open Approach. Journal of Clinical Medicine. 2023; 12(9):3193. https://doi.org/10.3390/jcm12093193
Chicago/Turabian StyleChiesa, Roberto, Enrico Rinaldi, Andrea Kahlberg, Sarah Tinaglia, Annarita Santoro, Giovanni Colacchio, and Germano Melissano. 2023. "Outcomes following Management of Complex Thoracoabdominal Aneurysm by an Open Approach" Journal of Clinical Medicine 12, no. 9: 3193. https://doi.org/10.3390/jcm12093193