The Journal of Thoracic and Cardiovascular Surgery
AdultIndependent associations with early mortality after open repair of Crawford extent IV thoracoabdominal aortic aneurysms
Video Abstract
Graphical abstract
Section snippets
Study Enrollment and Patient Characteristics
This was a study of consecutive extent IV TAAA repairs performed on our service from 1986 to 2021. Baylor College of Medicine's Institutional Review Board approved our clinical research protocol (#18095) in February 2006. Before this date, a waiver of consent was approved, and data were collected retrospectively from medical records. After this date, informed consent was obtained from patients or legally authorized representatives whenever possible; waivers of consent were approved for patients
Results
Between October 1986 and April 2021, our practice performed 3677 consecutive TAAA repairs, 721 of which were for an extent IV TAAA (Video Abstract). Of these 721 patients, 78 (10.8%) experienced an adverse event, including 49 (6.8%) operative deaths. We stratified our results by these events of interest.
Discussion
Crawford extent IV TAAA repair is associated with considerable risk for mortality and morbidity. In this study, 30-day mortality, operative mortality, and adverse event rates were 4.3% (n = 31), 6.8% (n = 49), and 10.8% (n = 78), respectively. Persistent stroke (n = 10, 1.4%) and persistent spinal cord deficit (n = 16, 2.2%) were infrequent events; however, persistent renal failure (n = 43, 6.0%) was a concern.
Comparisons with other contemporary series are hindered by the existence of few
Conclusions
Open repair of an extent IV TAAA is a formidable surgical procedure that poses significant risk. However, we have found that open repair of extent IV TAAAs that uses a predominantly clamp-and-sew technique and cold renal artery perfusion, along with a flexible patient-tailored approach to proximal and distal anastomoses and visceral or renal artery reattachment, is a durable procedure that can be performed with reasonable mortality and low rates of stroke and spinal cord deficit (Figure 4). The
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Commentary: Does 4 = 4?
2023, Journal of Thoracic and Cardiovascular Surgery
This work was not directly funded. Endowments from the Denton A. Cooley, MD, Chair in Cardiac Surgery (M.R.M.), the Jimmy and Roberta Howell Professorship in Cardiovascular Surgery at Baylor College of Medicine (S.A.L.), and the Cullen Foundation (J.S.C.) provided partial support to these faculty.