The Impact of Atherosclerosis on Short- and Long-Term Outcomes in Open Descending and Thoracoabdominal Aneurysm Repair
Presented During:
Thursday, April 25, 2024: 5:38PM - 7:00PM
Sheraton Times Square
Posted Room Name:
Central Park
Abstract No:
P0335
Submission Type:
Abstract Submission
Authors:
joshua chen (1), Christopher Pritting (1), Vishal Shah (1), Colin King (1), Jacqueline McGee (1), Megary McCoy (1), Konstadinos Plestis (1)
Institutions:
(1) Thomas Jefferson University Hospital, Philadelphia, PA
Submitting Author:
joshua chen
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Thomas Jefferson University Hospital
Thomas Jefferson University Hospital
Co-Author(s):
Christopher Pritting
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Thomas Jefferson University Hospital
Thomas Jefferson University Hospital
Vishal Shah
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Thomas Jefferson University Hospital
Thomas Jefferson University Hospital
Colin King
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Thomas Jefferson University Hospital
Thomas Jefferson University Hospital
Jacqueline McGee
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Thomas Jefferson University Hospital
Thomas Jefferson University Hospital
Megary McCoy
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Thomas Jefferson University Hospital
Thomas Jefferson University Hospital
Konstadinos Plestis
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Thomas Jefferson University Hospital
Thomas Jefferson University Hospital
Presenting Author:
joshua chen
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Abstract:
Objective: The gold standard for repair of descending thoracic (DTA) and thoracoabdominal aortic aneurysms (TAAA) is open surgery. Common etiologies of DTAs and TAAAs include medial degeneration (MD) and chronic type B aortic dissection (cTBAD). A subset of aneurysms, termed atherosclerotic aneurysms (AA), have atherosclerotic changes in the vessel wall with various degrees of thrombus. We analyzed the impact of atherosclerosis on the short- and long-term outcomes of patients undergoing open DTA or TAAA repair.
Methods: We performed a retrospective analysis of a prospectively maintained aortic database. From 1999 to 2023, 281 patients underwent open DTA or TAAA repair by a single surgeon. We compared preoperative comorbidities, postoperative complications, and in-hospital and long-term mortality for patients with cTBAD vs AA vs MD. Patients who underwent repair for other etiologies (acute dissection, infection, pseudoaneurysm, trauma) were excluded.
Results: Of the 120 cTBAD patients, open DTA and TAAA repair was performed in 50 (42%) and 70 (58%) patients, respectively. Of the 60 AA patients, 6 (10%) and 54 (90%) patients had open DTA and TAAA repair, respectively. Of the 65 MD patients, 17 (27%) and 48 (73%) patients had open DTA and TAAA repair, respectively. Patients with AA were significantly older (cTBAD: 57 [53-64] vs AA: 71 [66.8-76] vs MD: 68 [63-75] years, p<0.01) and more likely to be female (cTBAD: 30%, AA: 53.3% vs MD: 36.9%, p=0.01). Patients with cTBAD were less likely to have COPD (cTBAD: 21.7% vs AA: 50% vs MD: 40%, p<0.01) and diabetes (cTBAD: 10.8% vs AA: 26.7% vs. MD: 21.7%, p<0.01). There were no significant differences in in-hospital mortality between cTBAD, AA, and MD patients (cTBAD: 7.5% vs AA: 16.7% vs MD: 6.2%, p=0.08) as well as rates of paraplegia (0.8% vs 3.3% vs. 1.5%, p = 0.23), stroke (4.2% vs 5% vs. 1.5%, p=0.54), new renal insufficiency (13.3% vs 10% vs. 6.2%, p=0.31) and reoperation for bleeding (6.7% vs 6.7% vs 6.2%, p=0.999). Overall survival at 1-, 5-, 10-, and 15-years for cTBAD vs AA vs MD patients was 90% vs 65% vs 86%, 79% vs 52% vs 66%, 59% vs 37% vs 47%, and 50% vs 23% vs 35% respectively, p<0.01 (Figure 1).
Conclusions: There were no significant differences in postoperative complications between groups. Although there was a higher in-hospital mortality in the AA group, the difference did not reach statistical significance. The AA patients have a statistically significant decrease in long-term survival compared to cTBAD patients.
Methods: We performed a retrospective analysis of a prospectively maintained aortic database. From 1999 to 2023, 281 patients underwent open DTA or TAAA repair by a single surgeon. We compared preoperative comorbidities, postoperative complications, and in-hospital and long-term mortality for patients with cTBAD vs AA vs MD. Patients who underwent repair for other etiologies (acute dissection, infection, pseudoaneurysm, trauma) were excluded.
Results: Of the 120 cTBAD patients, open DTA and TAAA repair was performed in 50 (42%) and 70 (58%) patients, respectively. Of the 60 AA patients, 6 (10%) and 54 (90%) patients had open DTA and TAAA repair, respectively. Of the 65 MD patients, 17 (27%) and 48 (73%) patients had open DTA and TAAA repair, respectively. Patients with AA were significantly older (cTBAD: 57 [53-64] vs AA: 71 [66.8-76] vs MD: 68 [63-75] years, p<0.01) and more likely to be female (cTBAD: 30%, AA: 53.3% vs MD: 36.9%, p=0.01). Patients with cTBAD were less likely to have COPD (cTBAD: 21.7% vs AA: 50% vs MD: 40%, p<0.01) and diabetes (cTBAD: 10.8% vs AA: 26.7% vs. MD: 21.7%, p<0.01). There were no significant differences in in-hospital mortality between cTBAD, AA, and MD patients (cTBAD: 7.5% vs AA: 16.7% vs MD: 6.2%, p=0.08) as well as rates of paraplegia (0.8% vs 3.3% vs. 1.5%, p = 0.23), stroke (4.2% vs 5% vs. 1.5%, p=0.54), new renal insufficiency (13.3% vs 10% vs. 6.2%, p=0.31) and reoperation for bleeding (6.7% vs 6.7% vs 6.2%, p=0.999). Overall survival at 1-, 5-, 10-, and 15-years for cTBAD vs AA vs MD patients was 90% vs 65% vs 86%, 79% vs 52% vs 66%, 59% vs 37% vs 47%, and 50% vs 23% vs 35% respectively, p<0.01 (Figure 1).
Conclusions: There were no significant differences in postoperative complications between groups. Although there was a higher in-hospital mortality in the AA group, the difference did not reach statistical significance. The AA patients have a statistically significant decrease in long-term survival compared to cTBAD patients.
Aortic Symposium:
Descending/Thoracoabdominal Aorta
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