Durability of open surgical repair of type I-III thoracoabdominal aortic aneurysm

Latz, Christopher A.; Cambria, Richard P.; Patel, Virendra I.; Mohebali, Jahan; Ergül, Emel; Lancaster, Robert T.; Conrad, Mark F.; Clouse, W. Darrin

doi:10.1016/j.jvs.2018.10.110

Cited by 35 publications

(19 citation statements)

References 24 publications

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“…In our study of 3,309 TAAA repairs, the freedom from repair failure of repair was 94% at 15 years (3). Latz and colleagues reported similar findings of 90% freedom from reintervention at 10 years (11). In general, there appears a low risk of late graft infection; however, patients with heritable thoracic aortic disease are prone to late patch aneurysms and pseudoaneurysms (33,35).…”

Section: Discussionmentioning

confidence: 80%

Narrative review: open surgery for thoracoabdominal aortic aneurysm—is it still a horrible surgery?

Kothari¹,

Weldon²,

Köksoy³

et al. 2022

J Vis Surg

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With the introduction of endovascular stent graft technology, options are available for treating patients with thoracoabdominal aortic aneurysms (TAAAs). However, open repair, despite its invasiveness, is still considered the gold standard for managing TAAA. Because this operation necessitates a large incision and is associated with life-threatening operative risk and serious life-altering postoperative complications such as paraplegia and renal failure, open repair may be described with ominous adjectives such as terrifying or horrible. Even large-volume centers of excellence have a relatively high incidence of mortality and morbidity, which contributes to the serious reputation of this surgery. However, over the years, steps have been taken to help mitigate risks in open repair, including the use of left heart bypass, cerebrospinal fluid drainage, cold renal perfusion, and reimplantation of intercostal and lumbar arteries, and early outcomes have generally improved. Late durability of open repair is well established. Endovascular repair of less complex descending thoracic aortic aneurysms is widely considered a good alternative to open surgical repair;notably, these are aneurysms that do not involve the visceral arteries. Experimental endovascular approaches for repairing TAAAs are emerging, but a substantial subset of patients may remain better suited for open repair because of anatomic and other limitations as well as some significant risks that are associated with endovascular repair. Endovascular repair of aneurysms involving visceral branches may be challenging even with fenestrated or branched endovascular graft technology. For many patient groups undergoing TAAA repair, protective adjuncts and overall durability have imparted significant benefits and support the continued need for open repair, making it far from a horrible surgery.

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Section: Discussionmentioning

confidence: 80%

Narrative review: open surgery for thoracoabdominal aortic aneurysm—is it still a horrible surgery?

Kothari¹,

Weldon²,

Köksoy³

et al. 2022

J Vis Surg

View full text Add to dashboard Cite

show abstract

“…7 Several aortic centers have reported similar outcomes: operative mortality rates of 8% or lower, paraplegia 1% to 5%, stroke 2% to 4%, and renal failure necessitating dialysis 2% to 7%. [11][12][13][14] However, specific patient populations have a lower risk of complications. In the Baylor series, younger patients (≤50 years old) had a below-average risk of early mortality (2%), persistent paraplegia (1%), and renal failure necessitating dialysis (2%).…”

Section: Open Taaa Repair: Resultsmentioning

confidence: 99%

The Dos and Don’ts of Open and Endovascular Thoracoabdominal Aortic Aneurysm Repair

Hong

Coselli

Preventza

2020

Innovations�(Phila)

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“…Our use of adjuncts is not exhaustive; other aortic centers use evoked potential monitoring (motor or somatosensory), near-infrared spectroscopy monitoring, epidural cooling, spinal perfusing catheters or mesenteric shunting, or perform repair under hypothermic circulatory arrest. [10][11][12] Because extent II TAAA repair is the most extensive form of TAAA repair, it has traditionally carried the greatest risk. In the 1993 publication by Svensson and colleagues, 13 reflecting the Crawford's lifetime experience with open TAAA repair, the rate of postoperative spinal cord deficit was 31% after extent II TAAA Left heart bypass is initiated by placing a cannula in the left atrium via a left inferior pulmonary venotomy, which is then connected to the drainage line of the left heart bypass circuit.…”

Section: Open Surgical Repair Of Thoracoabdominal Aortic Aneurysmsmentioning

confidence: 99%

“…In contemporary series of open TAAA repairs, several aortic centers have reported an operative mortality rate of 8% or lower. 10,11,[16][17][18][19] Regarding postoperative complications, reported rates of paraplegia range from 1% to 5%, rates of stroke range from 2% to 4%, and rates of renal failure necessitating hemodialysis range from 2% to 7% at experienced centers. [10][11][12][16][17][18][19] Young patients ( 50 years) who undergo TAAA repair tend to have lower rates of postoperative complications than older patients; in our study of 445 young patients, we reported low rates of operative mortality (2%), persistent paraplegia (1%), and renal failure necessitating dialysis (2%).…”

Section: Open Surgical Repair Of Thoracoabdominal Aortic Aneurysmsmentioning

confidence: 99%

“…10,11,[16][17][18][19] Regarding postoperative complications, reported rates of paraplegia range from 1% to 5%, rates of stroke range from 2% to 4%, and rates of renal failure necessitating hemodialysis range from 2% to 7% at experienced centers. [10][11][12][16][17][18][19] Young patients ( 50 years) who undergo TAAA repair tend to have lower rates of postoperative complications than older patients; in our study of 445 young patients, we reported low rates of operative mortality (2%), persistent paraplegia (1%), and renal failure necessitating dialysis (2%). 20 Similarly, patients with Marfan syndrome and other heritable thoracic aortic diseases generally face a lower operative risk, 21 as do patients with chronic aortic dissection.…”

Section: Open Surgical Repair Of Thoracoabdominal Aortic Aneurysmsmentioning

confidence: 99%

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Open vs. endovascular thoracoabdominal aortic aneurysm repair: tale of the tape

Çekmeceli̇oğlu

Orozco-Sevilla

Coselli³

2020

Asian Cardiovasc Thorac Ann

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Open surgical repair persists as the gold-standard operation for thoracoabdominal aortic aneurysm; however, endovascular repair has become commonplace. Technical considerations in thoracoabdominal aortic aneurysm treatment are particularly complex, insofar as it involves critical branching arteries feeding the visceral organs. Newer, low-profile devices make total endovascular thoracoabdominal aortic aneurysm repair more feasible and, thus, appealing. For younger and low-risk patients, the choice between open and endovascular therapy remains controversial. Despite the advantages of a minimally invasive procedure, data suggest that endovascular aortic repair incurs a greater risk of spinal cord deficit, and the durability of endovascular aortic repair remains unclear. It is difficult to compare outcomes between endovascular and open thoracoabdominal aortic aneurysm repair, primarily because of the current investigational status of endovascular devices, the variety of approaches to endovascular repair, differing patient populations, lack of prospective randomized studies, and minimal medium- and long-tern follow-up data on endovascular repair. When deciding between open and endovascular approaches, one should consider which is more suitable for each patient. Older patients generally benefit from a less invasive approach. Open repair should be considered for young patients and those with heritable thoracic aortic disease. Infection and fistulae are best treated by open repair, although endovascular intervention as a lifesaving bridge to definitive repair has evolved to become a critical component of initial treatment. It is crucial to have technical expertise in both open and endovascular procedures to provide the best aortic repair for the patient. This may require dedicated aortic programs at tertiary institutions.

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Durability of open surgical repair of type I-III thoracoabdominal aortic aneurysm

Cited by 35 publications

References 24 publications

Narrative review: open surgery for thoracoabdominal aortic aneurysm—is it still a horrible surgery?

Narrative review: open surgery for thoracoabdominal aortic aneurysm—is it still a horrible surgery?

The Dos and Don’ts of Open and Endovascular Thoracoabdominal Aortic Aneurysm Repair

Open vs. endovascular thoracoabdominal aortic aneurysm repair: tale of the tape

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