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Ann Thorac Surg 2007;83:S851-S855
© 2007 The Society of Thoracic Surgeons

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Supplement

Long-Term Follow-Up After Thoracoabdominal Aortic Aneurysm Repair

^a Department of Cardiothoracic Surgery, St. Antonius Hospital, the Netherlands
^b Department of Cardiology Research and Statistical Analysis, St. Antonius Hospital, the Netherlands
^c Department of Anesthesiology and Intensive Care, St. Antonius Hospital, the Netherlands

^_* Address correspondence to Dr Schepens, St. Antonius Hospital, Department Cardiothoracic Surgery, Koekoekslaan 1, 3435 CM Nieuwegein, the Netherlands (Email: m.schepens{at}antonius.net).

Presented at Aortic Surgery Symposium X, New York, NY, April 27–28, 2006.

BACKGROUND: Early mortality and morbidity after thoracoabdominal aortic aneurysm (TAAA) repair has been analyzed extensively; however, very few studies have examined the risk factors for late death.

METHODS: We analyzed 500 consecutive TAAA repairs performed at St. Antonius Hospital between 1981 and March 30, 2006. Survival and freedom from aortic reoperation were calculated using the Kaplan-Meier method, and the effects of preoperative, intraoperative, and postoperative risk factors were evaluated using Cox proportional hazard analysis. Survival was compared with a Dutch population matched for age, sex, and date of operation.

RESULTS: Patient survival with 95% confidence intervals (CI) was 83% (80% to 86%), 63% (58% to 67%), 34% (29% to 40%), 16% (9% to 20%), and 6% (2% to 11%) after 1, 5, 10, 15, and 20 years, respectively, compared with 100%, 99%, 85%, 36%, and 15% for the matched Dutch population. Hazard analysis showed an early phase of high hazard falling to low levels 9 months postoperatively and a late phase in which the hazard of death gradually increased. Incremental risk factors for late death were depressed left ventricular function (p < 0.001), increased age (p < 0.001), urgency (p = 0.007), postoperative dialysis (p < 0.001), and postoperative neurologic deficit (p = 0.016). Freedom from reoperation on the aorta with 95% CI was 98% (97% to 99%), 92% (89% to 94%), 86% (82% to 90%), 83% (78% to 87%), and 83% (78% to 87%) after 1, 5, 10, 15, and 20 years, respectively.

CONCLUSIONS: Survival remains suboptimal, especially in the early years after TAAA repair, compared with a matched population. Avoidance of postoperative problems such as dialysis and neurologic deficits and performing elective surgery on relative young patients with unimpaired ventricular function will increase the likelihood of late survival.

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