Area of Science:

• Vascular Surgery
• Minimally Invasive Surgery
• Surgical Outcomes Research

Background:

• Laparoscopic aortic surgery aims to improve patient outcomes compared to conventional open surgery.
• Assessing the safety and efficacy of laparoscopic techniques in complex aortic procedures is crucial.

Purpose of the Study:

• To compare postoperative and medium-term outcomes of laparoscopic aortic surgery versus conventional open aortic surgery.
• To identify risk factors associated with adverse events in aortic surgery.

Main Methods:

• Prospective study of 228 patients undergoing aortic bypass surgery (abdominal aortic aneurysm or occlusive aortoiliac disease) from 2006-2011.
• Comparison between conventional open surgery (145 patients) and total laparoscopic repair (83 patients), matched using propensity scores.
• Composite endpoint for adverse events (AE) included mortality, reoperation for hemorrhage, myocardial infarction, stroke, respiratory failure, prosthesis infection/occlusion, and reoperation.

Main Results:

• Laparoscopic repair was associated with a significantly higher risk of AE within the first 30 postoperative days (p=0.03).
• Laparoscopic aortic technique (OR=4.50) and coronary artery disease (OR=4.67) were independent predictors of early postoperative AE.
• Laparoscopic aortic surgery was also linked to increased AE during follow-up (HR=4.40, p=0.002).

Conclusions:

• The laparoscopic approach for aortic surgery may increase the risk of adverse events, even when performed by a well-trained surgical team.
• Coronary artery disease is a significant independent risk factor for adverse events in aortic surgery patients.
• Further research is needed to clarify the role of laparoscopic techniques in specific aortic pathologies due to small patient numbers.