[Open surgical therapy of thoracoabdominal aortic aneurysms and chronic expanding aortic dissections: analysis of perioperative prognostic factors].

AIM OF THE STUDY

The aim of the study was to investigate perioperative prognostic factors and long-term outcome following conventional open repair (COR) of thoracoabdominal aortic aneurysms (TAAA) and chronic expanding aortic dissections (CEAD).

PATIENTS AND METHODS

Between March 1993 and December 2005, 92 patients underwent elective COR for TAAA or CEAD in our institution. Passive distal aortic perfusion during cross-clamping was used in 36 patients (39%). Medical records and imaging studies of all patients were reviewed. Follow-up included history, physical examination and CT or MR angiography. Median follow-up was 40 months (range 1-139 months).

RESULTS

Intraoperative, 30-day and in-hospital mortality rates were 2%, 8% and 12%, respectively. The estimated survival rate after 5 years was 70% and 43% of all deaths were cardiac related. The paraplegia rate was 10%, the rate of patients developing chronic renal failure requiring hemodialysis was 3% and 21% of patients required surgical revision. In multivariate analyses the need for surgical revision (OR: 8.465; CI: 0.802-89.318; p=0.024) and postoperative elevated serum transaminase values (OR: 1.009; CI: 1.002-1.017; p=0.017) independently predicted 30-day mortality. Peripheral arterial disease (OR: 4.41; CI:1.672-11.611; p=0.003), intraoperative complications such as disseminated intravasal coagulation and asystole (OR: 4.28; CI: 1.128-16.267; p=0.033), postoperative elevated bilirubin values >2.5 mg/dl (OR: 1.06; CI: 1.009-1.112; p=0.019), and postoperative ventilation >7 days (OR: 7.79; CI: 2.499-24.246; p<0,0001) independently predicted long-term mortality.

CONCLUSION

Postoperative elevated liver values represent negative prognostic factors and may indicate a more standardized use of active shunt systems for organ perfusion.