Postoperative Complications Decrease Long-Term Survival After Thoracic Aneurysm Repair Despite Apparently Successful “Rescue” From Early Mortality

Elective repair of thoracic aortic aneurysms is a prophylactic procedure performed when the risk of aneurysm rupture is judged to outweigh perioperative risk. It has been demonstrated that mortality because of any cause in the 5 years after repair in frail surgical candidates is high, despite the fact that perioperative mortality is relatively favorable and aortic-related death is reduced.1,2 Patient selection, therefore, is vital if survival gains are to be achieved through elective repair of thoracic aneurysms. Preoperative factors are known to affect life expectancy after surgery, but the effect of perioperative complications on subsequent survival has not been reported. Patients undergoing elective thoracic aneurysm repair for thoracic aortic aneurysm from the updated MOTHER (Medtronic Thoracic Endovascular Registry) were studied, which comprises 7 clinical trials and 1 institutional series.3 Subjects with aneurysmal chronic aortic dissection were excluded. Perioperative complications were classified as neurological, cardiac, renal, respiratory, or access vessel-related. For all clinical trials, adverse events were reported via the trial data-collection process and were adjudicated by a review panel according to trial protocol. For the St George’s Vascular Institute cohort, all adverse events were reviewed …