Morbidity and mortality after extent II thoracoabdominal aortic aneurysm repair.
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.
Coselli
Joseph S
JS
The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, and The Methodist DeBakey Heart Center, Houston, Texas 77030, USA. jcoselli@bcm.tmc.edu
LeMaire
Scott A
SA
Conklin
Lon D
LD
Köksoy
Cüneyt
C
Schmittling
Zachary C
ZC
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001014:Aortic Aneurysm / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D004630:Emergencies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010264:Paraplegia / Q000209:etiology; D011183:Postoperative Complications; D051437:Renal Insufficiency / Q000209:etiology; D012307:Risk Factors; D015996:Survival Rate; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000379:methods