P335. The Impact of Atherosclerosis on Short- and Long-Term Outcomes in Open Descending and Thoracoabdominal Aneurysm Repair
Presented During: POD Abstracts (Available for viewing in the exhibit hall for the duration of the meeting)
Thomas Jefferson University Hospital
philadelphia, PA
United States - Contact Me
Joshua Chen is a 3rd year medical student at Sidney Kimmel Medical College interested in a career in academic cardiothoracic surgery.
Thursday, April 25, 2024: 5:38 PM - 7:00 PM
Sheraton Times Square
Room: Central Park
Description
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.
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
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.
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
Presentation Duration
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