Open Descending and Thoracoabdominal Aortic Repairs in Patients Younger Than 50 Years Old

Abstract

Background. The purpose of this study was to redefine indications of open descending and thoracoabdominal aortic aneurysm repair in the younger population.Methods. Between 1991 and 2017, 2012 patients undergoing descending and thoracoabdominal aortic aneurysm repair at our institution were divided into 2 groups for comparison: younger (<50 years; 276 [14%]) and older ( ‡50 years; 1736 [86%]). Patient demographics and perioperative outcomes were retrospectively reviewed.Results. Younger patients had significantly more heritable thoracic aortic disease (HTAD; 53% vs 9%, P < .001) and chronic dissections (64% vs 26%, P < .001) and fewer comorbidities. The younger cohort underwent more extent II repairs (28% vs 15%, P < .001). Operative mortality was significantly lower in younger patients (6% vs 17%, P < .001). Significant disabling complications (composite of operative mortality, paraplegia/paraparesis, stroke, and dialysis) were seen in 17% of the younger patients and in 40% of older patients 40% (P < .001). In multivariate analysis, extent of repair and chronic obstructive pulmonary disease were independent

2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines

“…Open repair for any segment of the thoracic aorta has proven to be durable in extended follow-up. 10,11,13,14,19 Treatment failure after open repair of either the proximal or distal thoracic aorta requiring reintervention ranges from 1% to 7% in long-term (10-year) follow-up. 10-12 In patients without a genetic syndrome or residual aortopathy shown on a postoperative imaging, surveillance can be done at longer intervals.…”

Paraplegia After Open Surgical Repair Versus Thoracic Endovascular Aortic Repair for Thoracic Aortic Disease: A Retrospective Analysis of Japanese Administrative Data

“…7 Another singlecenter retrospective observational study in the United States reported that paraplegia/paraparesis occurred in 8.3% of 2,012 patients who underwent open descending and thoracoabdominal aortic aneurysm repair between 1991 and 2012. 8 In the study population, which did not include abdominal or thoracoabdominal aortic aneurysms, paraplegia occurred in less than 3% of both surgery groups. This was similar to the findings of Lou et al, which reported that postoperative paraplegia occurred in 3.4% of open surgical repair patients and 2.3% of TEVAR patients with type B aortic dissection.…”

Offener thorakaler und thorakoabdominaler Aortenersatz vs. f/b(T)EVAR – komplementär oder kompetitiv?

“…Es ergeben sich daraus aber auch nach wie vor klare Indikationen, die ein offenes Vorgehen rechtfertigen bzw. klar indiziert erscheinen lassen: ▪ Junges Patientenalter: Patienten < 50(-60) Jahre verkraften nicht nur ein OR besser, sie haben auch geringere Komplikationsraten und profitieren darüber hinaus vor allem aufgrund der geringen Re-Interventionsraten und Langzeitkomplikationen von einem offenen Vorgehen[23,24]. ▪ Bindegewebserkrankungen: In dieser Patientengruppe (z. B.Marfan-, Loyes-Dietz-oder vaskuläres Ehlers-Danlos-Syndrom) stellt aufgrund der speziellen Veränderungen des aortalen Bindegewebes das OR noch immer den Goldstandard dar[25].Allenfalls im Notfall hat hier die endovaskuläre Therapie einen Stellenwert, wobei dies nur als Bridging bis zu einer definitiven Therapie betrachtet wird [26].…”