Impact of previous thoracic aneurysm repair on thoracoabdominal aortic aneurysm management.
BACKGROUND
The purpose of this study was to determine the impact of previous thoracic aortic aneurysm repair (PTAR) on subsequent thoracoabdominal aortic aneurysm operations.


METHODS
A retrospective review of 723 thoracoabdominal aortic aneurysm repairs over a 10-year period facilitated comparison of 179 patients (24.8%) with PTAR and 544 patients (75.2%) without PTAR.


RESULTS
Patients with PTAR had more chronic dissections and extensive thoracoabdominal aortic aneurysms, and consequently required longer clamp and ischemic times and more intraoperative transfusions. Patients without PTAR were older, had more preoperative comorbid disease, and had more symptomatic or ruptured aneurysms. Although differences did not reach statistical significance, patients without PTAR tended toward increased in-hospital mortality (8.5% versus 4.5%; p = 0.078) and postoperative paraplegia/paraparesis rates (6.5% versus 2.8%; p = 0.069). More patients without PTAR had cardiac complications (11.3% versus 5.6%; p = 0.028) and required chronic hemodialysis (5.9% versus 1.1%; p = 0.009).


CONCLUSIONS
The presence of a PTAR did not adversely affect the outcome of thoracoabdominal aortic aneurysm repair. After thoracic aortic aneurysm repair, life-long radiologic surveillance and early surgical treatment are justified.
Coselli
J S
JS
Department of Surgery, Baylor College of Medicine, Methodist Hospital, Houston, Texas, USA.
Poli de Figueiredo
L F
LF
LeMaire
S A
SA
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000601:surgery; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001019:Aortic Rupture / Q000601:surgery; D001803:Blood Transfusion; D002315:Cardiopulmonary Bypass; D002908:Chronic Disease; D004194:Disease; D005260:Female; D005500:Follow-Up Studies; D006324:Heart Arrest, Induced; D006331:Heart Diseases / Q000209:etiology; D017052:Hospital Mortality; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D010264:Paraplegia / Q000209:etiology; D010291:Paresis / Q000209:etiology; D011159:Population Surveillance; D006435:Renal Dialysis; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome