Pulmonary complications after descending thoracic and thoracoabdominal aortic aneurysm repair: predictors, prevention, and treatment.
BACKGROUND
Although recent advances in surgical techniques have improved outcomes of descending thoracic (DTA) and thoracoabdominal aortic aneurysm (TAAA) repair, significant mortality and morbidity still occur. The aim of the current retrospective study is to determine predictors of postoperative pulmonary complications and prolonged hospital stay.


METHODS
Two hundred nineteen patients (median age, 66 years; range, 18 to 88; 112 male) underwent DTA (n = 79 [36%; 23 elephant trunk completions]) or TAAA (n = 140 [64%; Crawford I (52%), II (10%), III (11%), IV (7%); 31 elephant trunk completions]) between June 2002 and June 2005. Forty-one patients presented with ruptured aneurysms. Left atrial-to-femoral bypass was utilized in 51% of the patients. Femorofemoral bypass and distal aortic perfusion were used in 41% of the patients, deep hypothermic circulatory arrest (DHCA) was used in 43 patients (mean duration: 31 +/- 9 minutes); 8% were done with clamp-and-sew technique.


RESULTS
Adverse outcomes were seen in 21 patients (9.5%); hospital death in 13 (5.9%), and stroke in 13 (5 of whom died; 5.9%). Sixty patients (27%) experienced respiratory complications with prolonged postoperative ventilation (longer than 48 hours); 24 required tracheostomy (11%). Independent predictors of pulmonary complications after DTA/TAAA were TAAA (p = 0.03), preoperative blood urea nitrogen greater than 24 mg/dL (p = 0.03) and rupture (p = 0.09). The median hospital stay was 11 days (interquartile range, 6 to 35). Independent predictors of length of hospital stay were preoperative blood urea nitrogen (p = 0.045), postoperative bleeding (p < 0.005), reintubation (p = 0.001), tracheostomy (p < 0.0005), and transfusion of platelets (p = 0.008).


CONCLUSIONS
This contemporary experience demonstrates that preoperative renal insufficiency and extensive aneurysm are important predictors of respiratory complications after aortic aneurysm surgery.
Etz
Christian D
CD
Department of Cardiothoracic Surgery, Mount Sinai School of Medicine, New York, New York 10029, USA. christian.etz@mountsinai.org
Di Luozzo
Gabriele
G
Bello
Ricardo
R
Luehr
Maximilian
M
Khan
Muhammad Z
MZ
Bodian
Carol A
CA
Griepp
Randall B
RB
Plestis
Konstadinos A
KA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001019:Aortic Rupture / Q000601:surgery; D001806:Blood Urea Nitrogen; D005260:Female; D006470:Hemorrhage / Q000209:etiology; D017052:Hospital Mortality; D006801:Humans; D007442:Intubation, Intratracheal; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017713:Platelet Transfusion; D011379:Prognosis; D012120:Respiration Disorders / Q000209:etiology* / Q000517:prevention & control / Q000628:therapy; D012121:Respiration, Artificial; D014139:Tracheostomy; D014656:Vascular Surgical Procedures / Q000009:adverse effects* / Q000401:mortality