| Objective To evaluate the early results after thoracoabdominal aortic aneurysm(TAAA)repair and analyze the related risk factors.Methods Between January 2009 and December 2017,a total of 156 patients who underwent TAAA repair were included in our retrospective study and the clinical data was collected.The early outcome was assessed,and the related risk factors were analyzed with logistic regression model.Results There were 111 male patients and 45 female patients with a mean age of(40.4±10.9)years(range,19-65 years).The degree of repair according to Crawford classification was extent I in 6(3.8%),extent II in 128(82.1%),extent III in 20(12.8%),and extent IV in 2(1.3%).There were 9 early deaths(5.8%).Permanent spinal cord injury developed in 8 patients(5.1%).Thirty-six(23.1%)patients had acute renal failure,and 18 of them needed dialysis.Multivariate logistic analysis showed that age(OR=1.153,95%CI:1.034-1.285,P=0.010),packed red blood cell usage in operation(OR=1.382,95%CI:1.157-1.649,P=0.000)were independent risk factors of 30-day death.Aortic rupture(OR=42.922,95%CI:3.256-565.890,P=0.004),postoperative creatinine levels(OR=1.005,95%CI:1.001-1.008,P-0.013)were independent risk factors of spinal cord injury.Smoking(OR=2.613,95%CI:1.119-6.104,P=0.026),packed red blood cell usage in operation(OR=1.115,95%CI:1.044-1.191,P=0.001),reoperation for bleeding(OR=3.516,95%CI:1.324-9.338,P=0.012)were independent risk factors of acute renal failure.Conclusions Open repair of thoracoabdominal aortic aneurysm was safe with good early outcomes.The independent risk factors were identified as age,packed red blood cell usage in operation for 30-day death,and aortic rupture,postoperative creatinine levels for spinal cord injury,and smoking,packed red blood cell usage in operation,reoperation for bleeding for acute renal failure.Objective To investigate the middle-term outcome after surgical repair of thoracoabdominal aortic aneurysm(TAAA).Methods This study included 156 patients who underwent TAAA repair between January 2009 and December 2017 in our hospital.The clinical and follow-up data was collected.The outcomes examined included long-term survival,and freedom from reintervention on cardiovascular system using Kaplan-Meier survival methods,and the effects of preoperative,intraoperative,and postoperative risk factors were evaluated using Cox proportional hazard analysis.Results There were 111 male patients and 45 female patients with a mean age of(40.4±10.9)years(range,19-65 years).The mean maximal aortic size was(6.6±1.7)cm(range:5.0-16.0cm).The degree of repair was Crawford extent Ⅰ in 6(3.8%),extent Ⅱ in 128(82.1%),extent Ⅲ in 20(12.8%),and extent Ⅳ in 2(1.3%).Six repairs were emergency.The median usage of packed red blood cell in operation was 4 units(IQR:0-6 units),and fresh frozen plasm was 800 ml(IQR:0-1200 ml).The 30-day mortality was 5.8%.Permanent spinal cord injury developed in 8 patients(5.1%).Eighteen(11.5%)patients needed dialysis.At a mean follow-up time of 45 months(range:0-114 months),there were 15 late deaths.The actuarial survivals rate was(92.3±2.1)%and(85.8±3.1)%at 1 and 5 years,respectively.Incremental risk factors for late death were age(OR=1.039,95%CI:1.002-1.078,P=0.040),maximal aortic size(OR=1.314,95%CI:1.090-1.583,P=0.004),paraplegia(OR=5.559,95%CI:1.180-26.179,P=0.030),and packed red blood cell usage in operation(OR=1.126,95%CI:1.069-1,186,P=0.000).Freedom from reintervention on cardiovascular system was(95.8±1.7)%and(87.6±3.3)%at 1 and 5 years,respectively.Conclusions Middle-term survival after TAAA repair was good with low rate of reintervention.Age,maximal aortic size,packed red blood cell usage in operation,and paraplegia were the independent risk factors for late survival.Objective To assess the surgical outcome of thoracoabdominal aortic aneurysm(TAAA)repair in patients with Marfan syndrome.Methods Data were analyzed of 156 consecutive TAAA repairs performed between January 2009 and December 2017 in patients with MFS(group M,n=58)and without MFS(group N,n=98).Early postoperative results,midterm survival and reintervention were compared between groups.Results The 30-day mortality rate was significantly different between groups(0%for group M and 9.2%for group N,X2=5.616,P=0.018).There was no significant difference in spinal cord injury,renal failure,respiratory complications between the two groups.Follow-up was complete in all patients.The mean follow-up period was 43 months(range,3-114 months)for group M and 50 months(range,2-111 months)for group N,respectively.The actuarial survivals rate at 5 years did not significantly differ between groups[(89.2±4.6)%for group M and(83.8±4.1)%for group N,X2log-rank=2.719,P=0.099].Group M had more reinterventions than group N.Actuarial rates of freedom from all reinterventions at 5 years in group M and group N were(72.7±8.4)%and(95.2 ±2.3)%(X2log-rank=5.034,P=0.025),respectively.Conclusions For patients with MFS,TAAA repair provides lower 30-day mortality and comparative midterm survival.But the reintervention rate was higher when compared with non-MFS patients,and the strict surveillance was necessary.Objective To evaluate the early and middle-term results after thoracoabdominal aortic aneurysm(TAAA)repair in patients with DeBakey type Ⅰ versus type Ⅲ aortic dissection.Methods Between January 2009 and December 2017,130 patients underwent open TAAA repair for chronic DeBakey type Ⅰ(group Ⅰ,n=47)and type Ⅲ(group Ⅲ,n=83)aortic dissections.Early postoperative results,middle-term follow-up results were compared between groups.Results The 30-day mortality rate was 6.9%(n=9)in the overall cohort.Spinal cord injury developed in 9 patients(6.9%).Thirty-six(23.1%)patients had acute renal failure,and 18 of them needed dialysis.Although there was no significant difference between the two groups,the group I had higher 30-day mortality(10.6%in group Ⅰ and 4.8%in group Ⅲ,X2=0.803,P=0.370),but the group Ⅲ had elevated incidence of reoperation for bleeding(22.9%vs.10.6%,X2=2.993,P=0.084),pneumonia(20.5%vs.10.6%,X2=2.068,P=0.150),and hemodialysis(18.1%vs.6.4%,X2=3.437,P=0.064)than group Ⅰ.The actuarial survivals rate at 5 years was(81.7 ± 5.9)%for group Ⅰand(87.2±4.2)%for group Ⅲ(X2=0.483,P=0.487).Freedom from all reinterventions at 5 years was similar between the groups[(84.5±6.7)%for group Ⅰ and(85.5±4.8)%for group Ⅲ,X2=0.010,P=0.920].Conclusions Although it did not reach statistical significance,DeBakey type Ⅰ had higher perioperative mortality than type Ⅲ,and DeBakey type Ⅲappeared to increase perioperative major adverse events when compared with type Ⅰ.Middle-term survival and freedom from cardiovascular-related reintervention were similar for both groups. |
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