Reoperative surgery on the thoracoabdominal aorta

Area of Science:

• Vascular Surgery
• Aortic Aneurysm Repair
• Surgical Outcomes Research

Background:

• Endovascular repair for aortic aneurysms is common.
• Patients with prior open distal aortic repair are often considered high-risk for reoperative procedures.

Purpose of the Study:

• To compare outcomes between reoperative and non-reoperative thoracoabdominal aortic aneurysm (TAAA) repair.
• To determine if previous aortic repair increases risk in subsequent TAAA surgery.

Main Methods:

• Retrospective review of 3379 TAAA repairs (1986-2016).
• Comparison of preoperative characteristics, surgical variables, and outcomes between reoperative (n=726) and non-reoperative (n=2653) cases.
• Multivariable analysis to identify predictors of adverse events.

Main Results:

• No significant difference in operative mortality between reoperative (8.1%) and non-reoperative (7.3%) TAAA repair.
• Reoperative repair was not associated with increased early adverse event risk.
• Kaplan-Meier survival analysis revealed significantly worse survival in reoperative groups within 10 years (23.9%-28.4%) compared to non-reoperative (40.1%).

Conclusions:

• Early outcomes for reoperative and non-reoperative TAAA repair are comparable.
• Mid-term follow-up indicates poorer survival rates for patients undergoing reoperative TAAA surgery.