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Ann Thorac Surg 2002;73:1107-1116
© 2002 The Society of Thoracic Surgeons

J. Maxwell Chamberlain memorial paper

Morbidity and mortality after extent II thoracoabdominal aortic aneurysm repair

Joseph S. Coselli, MD*a, Scott A. LeMaire, MDa, Lori D. Conklin, MDa, Cüneyt Köksoy, MDa, Zachary C. Schmittling, MDa

a The Michael E. DeBakey Department of Surgery, Division of Cardiothoracic Surgery, Baylor College of Medicine, and The Methodist DeBakey Heart Center, Houston, Texas USA

* Address reprint requests to Dr Coselli, The Michael E. DeBakey Department of Surgery, Division of Cardiothoracic Surgery, Baylor College of Medicine, 6560 Fannin St, Suite 1100, Houston, TX 77030 USA
e-mail: jcoselli{at}bcm.tmc.edu

Presented at the Thirty-seventh Annual Meeting of The Society of Thoracic Surgeons, New Orleans, LA, Jan 29–31, 2001.

Abstract

Background. Surgical repair of Crawford extent II thoracoabdominal aortic aneurysms (TAAAs) carries substantial risk for morbidity and mortality. The purpose of this study was to analyze the results of a large consecutive series of extent II TAAA repairs and identify factors that influence morbidity and survival.

Methods. Of 1,415 consecutive patients who underwent TAAA operations over a 13-year period, 442 (31.2%) had extent II repairs. Data from a prospectively maintained database were analyzed to determine which factors were associated with death and major complications.

Results. The operative mortality was 10.0% (44 patients). Postoperative complications included paraplegia/paraparesis in 33 patients (7.5%), pulmonary complications in 158 (35.7%), and renal failure in 69 (15.9%). Multivariable analysis revealed that renal insufficiency (odds ratio [OR] 2.6), increasing age (OR 1.1/year), and increasing red blood cell transfusion requirements (OR 1.1/U) were predictors for mortality; renal insufficiency (OR 2.8) and peptic ulcer disease (OR 9.3) were predictors of renal failure; and rupture (OR 6.3) was a predictor of paraplegia. Left heart bypass was an independent protective factor against paraplegia (OR 0.4).

Conclusions. This contemporary experience demonstrates acceptable levels of morbidity and mortality in this high-risk group. Left heart bypass was found to provide protection against paraplegia in these patients.




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