Outcomes of Staged Completion Extent II Thoracoabdominal Aortic Aneurysm Repair

P0245 

Abstract Submission 

Yuki Ikeno (1), Lucas Ribe (1), Alexander Mills (1), Harleen Sandhu (1), Rana Afifi (1), Charles Miller (1), Hazim Safi (1), Anthony Estrera (1), Akiko Tanaka (1)

(1) McGovern Medical School at UTHealth, Houston, TX

Yuki Ikeno    -  Contact Me
McGovern Medical School at UTHealth

Lucas Ribe    -  Contact Me
McGovern Medical School at UTHealth

Alexander Mills    -  Contact Me
McGovern Medical School at UTHealth

Harleen Sandhu    -  Contact Me
McGovern Medical School at UTHealth

Rana Afifi    -  Contact Me
McGovern Medical School at UTHealth

Charles Miller    -  Contact Me
McGovern Medical School at UTHealth

Hazim Safi    -  Contact Me
McGovern Medical School at UTHealth

*Anthony Estrera    -  Contact Me
McGovern Medical School at UTHealth

Akiko Tanaka    -  Contact Me
McGovern Medical School at UTHealth

Yuki Ikeno    -  Contact Me
McGovern Medical School at UTHealth

Objective:
Patients with thoracoabdominal aortic aneurysms (TAAAs) may present with mildly enlarged abdominal segments. After TAAA repair limited to resect the aneurysmal lesion, patient may require completion extent II in the future, which may be more high-risk. We sought to examine our outcomes with staged-completion TAAA repair.

Methods:
We retrospectively reviewed patients who underwent primary and redo-completion extent II TAAA repairs between 1999 and 2019. Primary repair was defined as single-stage extent II TAAA repair at initial encounter. Completion repair was defined as staged-aortic repair with a prior distal aortic repair to replace the entire extent II TAAA in continuity. Preoperative patient characteristics and perioperative outcomes in the two repair groups were compared.

Results:
141 primary and 105 completion extent II TAAA repairs were performed during the study period. Patient baseline characteristics were similar except for more frequent hypertension in completion repair group and previous elephant trunk procedure in primary repair group. The extent of repairs performed to achieve the completion extent II repair included descending in 8%, extent I in 3 %, extent II in 18%, extent III in 34%, extent IV in 35%, and extent V in 2%. Paraplegia rate was twice as high in the primary repair compared to completion repair (14% vs. 7%, p=0.067); Permanent paraplegia rate was 9% and 6%, respectively (p=0.469) Pump time and clamp time were significantly longer in primary repairs compared to completion repairs, but 30-day mortality (11% vs. 14%, p=0.543), respiratory failure, dialysis requirement, and stroke rates did not differ in two groups.

Conclusions:
Outcomes after staged-completion extent II TAAA repairs were comparable to that of primary extent II repairs. Staging the repair may reduce the risk of paraplegia after extent II repairs. Without significant enlargement of the abdominal segment, a limited initial repair with expectant completion extent II repair is a reasonable approach.

Descending/Thoracoabdominal Aorta