Long-term follow-up after thoracoabdominal aortic aneurysm repair.
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.
Schepens
Marc A A M
MA
Department of Cardiothoracic Surgery, St. Antonius Hospital, The Netherlands. m.schepens@antonius.net
Kelder
Johannes C
JC
Morshuis
Wim J
WJ
Heijmen
Robin H
RH
van Dongen
Eric P
EP
ter Beek
Huub T M
HT
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology; D016016:Proportional Hazards Models; D006435:Renal Dialysis; D012086:Reoperation / Q000706:statistics & numerical data; D012307:Risk Factors; D016019:Survival Analysis; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D018487:Ventricular Dysfunction, Left / Q000209:etiology