Morbidity and mortality after extent II thoracoabdominal aortic aneurysm repair

被引:157
作者
Coselli, JS
LeMaire, SA
Conklin, LD
Köksoy, C
Schmittling, ZC
机构
[1] Baylor Coll Med, Div Cardiothorac Surg, Michael E DeBakey Dept Surg, Houston, TX 77030 USA
[2] Methodist DeBakey Heart Ctr, Houston, TX USA
关键词
D O I
10.1016/S0003-4975(02)03370-2
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background. Surgical repair of Crawford extent II thoracoabdominal aortic aneurysms (TAAAs) carries substantial risk for morbidity and mortality. The purpose of this study was to analyze the results of a large consecutive series of extent II TAAA repairs and identify factors that influence morbidity and survival. Methods. Of 1,415 consecutive patients who underwent TAAA operations over a 13-year period, 442 (31.2%) had extent II repairs. Data from a prospectively maintained database were analyzed to determine which factors were associated with death and major complications. Results. The operative mortality was 10.0% (44 patients). Postoperative complications included paraplegia/paraparesis in 33 patients (7.5%), pulmonary complications in 158 (35.7%), and renal failure in 69 (15.9%). Multivariable analysis revealed that renal insufficiency (adds ratio [OR] 2.6), increasing age (OR 1.1/year), and increasing red blood cell transfusion requirements (OR 1.1/U) were predictors for mortality; renal insufficiency (OR 2.8) and peptic ulcer disease (OR 9.3) were predictors of renal failure; and rupture (OR 6.3) was a predictor of paraplegia. Left heart bypass was an independent protective factor against paraplegia (OR 0.4). Conclusions. This contemporary experience demonstrates acceptable levels of morbidity and mortality in this high-risk group. Left heart bypass was found to provide protection against paraplegia in these patients. (C) 2002 by The Society of Thoracic Surgeons.
引用
收藏
页码:1107 / 1115
页数:9
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