Long-term survival after descending thoracic and thoracoabdominal aortic aneurysm repair.

Abstract Objective Patients with descending thoracic or thoracoabdominal aortic aneurysms (dTAA or TAAA) often have a variety of medical comorbidities. Those that are deemed acceptable for intervention undergo complicated repairs with good early outcomes. The purpose of this study was to identify variables that were associated with mortality over time. Methods This was a retrospective review of a prospectively maintained database at our institution from 1983-2015. Patients were included if they underwent open or endovascular repair for dTAAs and TAAAs. Patients were excluded if they were intervened on for traumatic transections. The primary outcome for the study was long-term survival. Secondary outcomes included aortic-related mortality. We had mortality/survival data on all patients. Results A total of 946 patients met our study criteria with a median follow-up of 102.8 months [IQR 58.9-148.2 months]. The median age of the cohort was 71 years [IQR 63-77 years] with the majority of patients being male (58.1%). The extent of TAAA pathology was as follows: Type I (14.2%), Type II (21.2%), Type III (17.1%), Type IV (26.2%), and dTAA (21.2%). A total of 147 (15.5%) patients had a prior dissection. The median diameter of aneurysm was 6.4cm [IQR 6.0-7.0cm]. A total of 158 (16.7%) patients underwent endovascular repair over the study period. Variables associated with mortality over time were: age, surgical era, acute pathology, dissection, preoperative creatinine, and Type IV TAAAs. In addition, experiencing the following complications in the postoperative period was associated with mortality over time: neurological, cardiac, and pulmonary. Aortic related mortality was 2.1% (n=20) over the study period. Patients that underwent endovascular repair for acute conditions had better long-term survival when compared to open. However, there were no differences in long-term survival between open and endovascular repair for non-acute cases. In addition, repair in the more modern era was associated with improved survival. Conclusion TAAAs can be repaired with reasonable perioperative mortality rates. Once patients undergo repair of their aneurysm, aortic-related mortality remains low. The addition of endovascular options has dramatically changed management of patients with dTAAs and TAAAs. Further, endovascular repair was associated with reduced perioperative mortality and significantly increased long-term survival in acute patients. Patients undergoing TAAA repair are generally considered high-risk and therefore require extensive long-term follow-up for management of their comorbidities and complications as these are the main contributors to mortality over time.