Muhammad Ali A. Rana, Peter Gloviczki, Harbuzariu Catalin, Audra Duncan, Manju Kalra, Gustavo S. Oderich, Mark D. Fleming, Thomas C. Bower
Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN.
OBJECTIVES: Various techniques are used for repair of thoracoabdominal aortic aneurysms (TAAAs). This study compares outcomes following repair of Type 3 and 4 TAAAs using 3 different techniques at a tertiary care institution over the same time period.
METHODS: One hundred twenty-one consecutive patients (83 male, 38 female) with 52 Type 3 and 69 Type 4 TAAAs underwent elective repair between 1999 and 2011. Group 1 (65 patients) – clamp-and-sew technique; Group 2 (31 patients) – left atrio femoral bypass; Group 3 (25 patients) – visceral branching technique of Ballard. There was no difference in cardiac and pulmonary risk factors, aneurysm size or presence of dissection; 12% of Group 3 was on dialysis pre-operatively (vs. 2% and 0% in groups 1 and 2). Eighty-four percent of the patients had perioperative spinal fluid drainage.
RESULTS: Procedure duration was longest in Group 3 (9.1 vs. 7.7 and 5.7 hours, for 1 and 2; p<0.001) but transfusion requirement was largest in Group 2 (3.5 liters vs. 1.7 and 2.1, for 1 and 3). Mean ICU and hospital stays were the same (9, 10 and 8 days: p=0.82; 18, 20 & 18 days: p=0.76). Cardiac (p=0.82), respiratory (p=0.43) and renal (p=0.07) complications were not different between groups. Spinal cord injury occurred in 6%, and it was not different among groups (3%, 10% and 8%; p=0.21). Thirty-day mortality was 6.6%, not different in groups 1-3 (6%, 10%, 4%; p=0.68). Median follow-up was 45 (±42) months with median survival of 84, 73 and 40 months in Groups 1-3, respectively (p=0.49). Estimated overall survival at 5 and 10 years was 65% and 23%.
CONCLUSIONS: For repair of Types 3 and 4 TAAAs, the Ballard aortic branching technique had the longest duration, but the clamp-and-sew technique had the lowest transfusion requirements. Complications, early and late mortality, and spinal cord injury were the same using the clamp-and-sew technique, atrio femoral bypass or the Ballard techniques.
AUTHOR DISCLOSURES: T. C. Bower: Nothing to disclose; H. Catalin: Nothing to disclose; A. Duncan: Nothing to disclose; M. D. Fleming: Nothing to disclose; P. Gloviczki: Nothing to disclose; M. Kalra: Nothing to disclose; G. S. Oderich: Cook Medical, Consulting fees or other remuneration (payment); Gore, Consulting fees or other remuneration (payment); M. A. Rana: Nothing to disclose
Posted March 2013