title: Impact of preoperative pulmonary function on outcomes after open repair of descending and thoracoabdominal aortic aneurysms.
abstract: To evaluate the impact of preoperative pulmonary function on outcomes after open repair of descending thoracic (DTA) and thoracoabdominal aortic (TAAA) aneurysms.
  
  
  
  The outcomes of patients undergoing open repair of DTA or TAAA were analyzed in relation to the results of preoperative pulmonary function tests. Receiver operating characteristic was adopted to assess the effect of forced expiratory volume in one second (FEV1) on the incidence of mortality. Logistic regression analysis and propensity score matching were used.
  
  
  
  Between 1997 and 2015, 726 patients underwent open DTA or TAAA repair. Pulmonary function tests were available in 711 (97.9%). Receiver operating characteristic analysis revealed the cutoff value of FEV1 to be 50%. Propensity score matching led to 149 pairs of patients with FEV1 below and above 50% with only limited residual imbalance. In the matched population operative mortality was 11.4% and 6.0% in patients with FEV1 ≤ 50% and FEV1 ≥ 51%, respectively (P = .10). The incidence of major adverse events was 33.1% in cases with FEV1 ≤ 50% and 19.5% in those with FEV1 ≥ 51% (P = .008). FEV1 ≤ 50% was associated with a 6.99× increase in the risk of major postoperative adverse events at logistic regression analysis.
  
  
  
  Preoperative FEV1 < 50% is strongly predictive of increased respiratory failure, tracheostomy, and operative mortality in patients undergoing open DTA/TAAA repair. For these very high-risk patients with either extensive TAAAs or anatomy unsuitable for endovascular repair, medical therapy may offer the best long-term survival.
authors.affiliation: Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY. Electronic address: lngirard@med.cornell.edu.
authors.forename: Leonard N
authors.initials: LN
authors.lastname: Girardi
authors.affiliation: Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY.
authors.forename: Christopher
authors.initials: C
authors.lastname: Lau
authors.affiliation: Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY.
authors.forename: Monica
authors.initials: M
authors.lastname: Munjal
authors.affiliation: Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Elsayed
authors.affiliation: Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY.
authors.forename: Ivancarmine
authors.initials: I
authors.lastname: Gambardella
authors.affiliation: Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY.
authors.forename: Lucas B
authors.initials: LB
authors.lastname: Ohmes
authors.affiliation: Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY.
authors.forename: Mario
authors.initials: M
authors.lastname: Gaudino
mesh_terms: D000368:Aged; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume / Q000502:physiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology*; D057234:Preoperative Period; D057216:Propensity Score; D012372:ROC Curve; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome
keywords: aortic aneurysm; descending thoracic aortic aneurysm; open repair; preoperative pulmonary function; thoracoabdominal aortic aneurysm