Early Gastrointestinal Complications After Open Thoracoabdominal Aortic Aneurysm Repair

Frankel, William C.; Green, Susan Y.; Amarasekara, Hiruni S.; Zhang, Qianzi; Preventza, Ourania; LeMaire, Scott A.; Coselli, Joseph S.

doi:10.1016/j.athoracsur.2020.09.032

Cited by 13 publications

(5 citation statements)

References 27 publications

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“…Gastrointestinal complications might be underestimated in already-published reports. In a recent series of 3587 open TAAA repairs, they occurred in 5.9% of cases [40]. Complication rates vary according to the proportion of patients treated emergently, the proportion of extended TAAAs (Type I, II, and III TAAAs vs.…”

Section: Early Resultsmentioning

confidence: 99%

Comparison of Immediate, Medium, and Long-Term Postoperative Results of Open Surgery and Fenestrated/Branched Stent Grafts for Extended Thoracoabdominal Aortic Aneurysms

Cochennec,

Couture,

Chiche

2023

JCM

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The optimal surgical treatment for extended thoracoabdominal aortic aneurysms (TAAAs) is still a matter of debate. The historical treatment is open repair (OR), but over the past fifteen years, endovascular strategies have gained widespread acceptance. Although several endovascular techniques have been described for the treatment of TAAAs, fenestrated and branched stent grafts (F/BEVARs) are the most frequently used and best documented. They have become the first-line treatment for both high- and moderate-risk surgical patients in most vascular centers. However, no randomized study comparing OR and F/BEVAR has been published, and decision-making is mainly based on the physician’s preference and/or hospital expertise. The objective of this manuscript is to provide an overview of current comparative data for OR and F/BEVAR.

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Section: Early Resultsmentioning

confidence: 99%

Comparison of Immediate, Medium, and Long-Term Postoperative Results of Open Surgery and Fenestrated/Branched Stent Grafts for Extended Thoracoabdominal Aortic Aneurysms

Cochennec,

Couture,

Chiche

2023

JCM

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“…Bleeding was one of the main clinical presentations of gastrointestinal complications, accounting for 57.3% of GICs, and it was similar to the findings in patients undergoing open thoracoabdominal aortic aneurysm repair. 6 Occurrence of GICs postoperatively contribute to higher mortality in hospital, longer stay in the ICU, and longer hospital stay. Our data showed that advanced age, ASA (>grade III), lower pre-induction MAP, longer aortic cross-clamp time, longer CPB time, and more intraoperative transfusion of red blood cells were independent risk factors for GICs by binary logistic regression analysis.…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4] Some studies reported that the morbidity of GICs was 1.6-6.4% after aortic surgery, but the mortality was 23-34%. [2][3][4][5][6][7][8] It has been reported that GICs were the major causes of death after aortic surgery. 9 The symptoms of GICs are varied and not easy to diagnose early.…”

Section: Introductionmentioning

confidence: 99%

“…10 At present, the gastrointestinal complications after aortic surgery are mainly focused on aneurysm surgery, and there are few studies on aortic dissection. [2][3][4][5][6][7][8] The purpose of this study was to identify the incidence, risk factors of GICs after open surgery for TAAD at our institution, and to analyze their short-term outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Risk Factors and Early Outcomes for Gastrointestinal Complications in Patients Undergoing Open Surgery for Type A Aortic Dissection

Liu

Gao

et al. 2023

The American Surgeon™

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Background Gastrointestinal complications need to be paid more attention, especially in critically ill patients. The purpose of this study was to identify the risk factors and short-term outcomes of gastrointestinal complications after open surgery for type A aortic dissection. Methods A retrospective single-institutional study including patients who underwent open surgery for type A aortic dissection during 2012-2020 was conducted. Univariate analysis and logistic regression analysis were used to identify risk factors associated with gastrointestinal complications. The related clinical outcomes were compared between the patients with and without gastrointestinal complications. Results Among the 2746 patients, 150 developed gastrointestinal complications. The development of gastrointestinal complications contributed to the higher rate of mortality ( P = .008), longer stay in the intensive care unit ( P < .001), and longer hospital stay ( P < .001). Logistic regression analysis showed that age (odds ratio [OR] 1.020; 95% confidence interval [CI] 1.005-1.057; P = .011), American Society of Anesthesiologists classification greater than grade III (OR 1.724; 95%CI 1.179-2.521, P = .005), pre-induction mean arterial pressure (OR 0.978; 95%CI 0.965-0.990, P = .001), aortic cross-clamp time (OR 1.012; 95%CI 1.005-1.019, P = .001), cardiopulmonary bypass time (OR 1.007; 95%CI 1.002-1.011, P = .002), and intraoperative transfusion of red blood cells (OR 1.214; 95%CI 1.122-1.314, P = .001) were independent risk factors for gastrointestinal complications. Conclusions The incidence of gastrointestinal complications after open surgery for type A aortic dissection was 5.5%, resulting in increased mortality and prolonged hospital stay. It is necessary to take suitable strategies to reduce the incidence of gastrointestinal complications.

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“…The visceral perfusion is selected to avoid the splanchnic hypoperfusion and to reduce gastrointestinal complications. Gastrointestinal complications are a greater risk factor for mortality and require secondary interventions, longer intensive care unit (ICU) stay, and hospital stays ( 39 ). The mid and long-term survival was markedly poorer for patients who developed gastrointestinal complications ( 36 ).…”

Section: Discussionmentioning

confidence: 99%

The application of modular multifunctional left heart bypass circuit system integrated with ultrafiltration in thoracoabdominal aortic aneurysm repair

Huang

Chen

et al. 2022

Front. Cardiovasc. Med.

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Open thoracoabdominal aortic aneurysm (TAAA) repair is a complex and challenging operation with a high incidence of serious complications, and high perioperative mortality and morbidity. Left heart bypass (LHB) is a circulatory support system used to perfuse the distal aorta during TAAA operation, and the advantages of LHB include guaranteeing distal perfusion, reducing the use of heparin, and diminishing the risk of bleeding and postoperative neurological deficits. In China, the circuit for TAAA repair is deficient, and far from the perfusion requirements. We designed a modular multifunctional LHB circuit for TAAA repair. The modular circuit consisted of cannulation pipelines, functional consumables connection pipelines, and accessory pipelines. The accessory pipelines make up lines for selective visceral perfusion and kidney perfusion, suckers and rapid infusion. The circuit can be assembled according to surgical requirements. The ultrafilter and heat exchanger are integrated into the circuit to fulfill the basic demands of LHB. The LHB circuit also has pipelines for selective visceral perfusion to the celiac artery and superior mesenteric artery and renal perfusion pipelines. Meanwhile, the reserved pipelines facilitate the quick switch from LHB to conventional cardiopulmonary bypass (CPB). The reserved pipelines reduce the time of reassembling the CPB circuit. Moreover, the rapid infusion was integrated into the LHB circuit, which can rapid infusion when massive hemorrhage during the open procedures such as exposure and reconstruction of the aorta. The ultrafiltration can diminish the consequent hemodilution of hemorrhage and rapid infusion. A hemoperfusion cartridge also can be added to reduce the systemic inflammatory during operation. The circuit can meet the needs of LHB and quickly switch to conventional CPB. No oxygenator was required during LHB, which reduce the use of heparin and reduce the risk of bleeding. The heat exchanger contributes to temperature regulation; ultrafiltration, arterial filter, and rapid-infusion facilitated the blood volume management and are useful to maintain hemodynamic stability. This circuit made the assembly of the LHB circuit more easily, and more efficient, which may contribute to the TAAA repair operation performed in lower volume centers easily. 26 patients who received TAAA repair under the modular multifunctional LHB from January 2018-March 2022 were analyzed, and we achieved acceptable clinical outcomes. The in-hospital mortality and 30-day postoperative mortality were 15.4%, and the postoperative incidences of paraparesis (4%), stroke (4%), and AKI need hemodialysis (12%) were not particularly high, based on the limited patients sample size in short research period duration.

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Early Gastrointestinal Complications After Open Thoracoabdominal Aortic Aneurysm Repair

Cited by 13 publications

References 27 publications

Comparison of Immediate, Medium, and Long-Term Postoperative Results of Open Surgery and Fenestrated/Branched Stent Grafts for Extended Thoracoabdominal Aortic Aneurysms

Comparison of Immediate, Medium, and Long-Term Postoperative Results of Open Surgery and Fenestrated/Branched Stent Grafts for Extended Thoracoabdominal Aortic Aneurysms

Risk Factors and Early Outcomes for Gastrointestinal Complications in Patients Undergoing Open Surgery for Type A Aortic Dissection

The application of modular multifunctional left heart bypass circuit system integrated with ultrafiltration in thoracoabdominal aortic aneurysm repair

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