Adult: Aorta
Our experience with 1000 recent thoracoabdominal aneurysm repairs, including endovascular stenting

Read at the 102nd Annual Meeting of The American Association for Thoracic Surgery, Boston, Massachusetts, May 14-17, 2022.
https://doi.org/10.1016/j.jtcvs.2022.03.026Get rights and content

Abstract

Objective

Managing patients with thoracoabdominal aneurysms is demanding yet fascinating, and requires a team effort. This invited talk presents lessons learned as our history with open and endovascular procedures evolved for 2578 descending and thoracoabdominal repairs over the past 20 years.

Methods

Beginning in 1985 with an analysis of 596 traumatic aortic ruptures and the risk of spinal cord ischemia, the evolution of research and procedures for thoracoabdominal aneurysms progressed. The focus of these studies, medication trials, and procedure adjustments was on lowering the risk of spinal cord ischemia.

Results

Between January 2002 and December 2021, 2578 aneurysm repairs were performed. The respective mortality rates were 6.8% and 4.0% for all patients treated. The permanent spinal cord ischemia rates were 1.3% for open descending thoracic aortas and 4.9% for open thoracoabdominal aneurysms. A detailed analysis of open and thoracoabdominal repairs showed better long-term outcomes with open repairs.

Conclusions

Through multiple randomized trials and innovations with procedures and techniques, the risk of death and spinal cord ischemia have been reduced. Long-term survival has also been improved. The pursuit of reducing the risks of descending and ascending thoracoabdominal repairs is a fascinating endeavor that has resulted in better patient outcomes. Nevertheless, this is a journey, and there will always be more room to achieve even better results.

Section snippets

Conclusions

The pursuit of reducing the risks of DTA and TAA repairs, apart from the difficult challenges of arch surgery,39 has been a fascinating and engrossing endeavor that, fortunately, has resulted in better outcomes for patients—something that was always at the forefront of taking on these challenging operations in these sick patients.

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Supported by the Marty and Michelle Weinberg and Family Fund; the Delos M. Cosgrove, MD, Chair for Heart Disease Research Fund; and the HVTI Chairman's Research Fund.

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