Abstract 19009: Surgical Repair of the Descending and Thoracoabdominal Aorta in Patients With Connective Tissue Disorders
Introduction: Patients with connective tissue disorders (CTD) are at increased risk of developing aneurysm or dissection of the descending and thoracoabdominal aorta (DTA/TAAA). Recently, endovascular repair (TEVAR) has been applied to these patients in order to reduce the operative risk
Hypothesis: We aim to review our result of open surgical repair in this group of patients to establish if the operative risk is high enough to justify an endovascular approach
Methods: We interrogated our prospectively maintained database (1998-2014) and identified 37 patients with CTD who underwent open DTA/TAAA repair.
Results: Twenty-five patients underwent TAAA and 12 patients DTA surgery. Median age was 41 years (56.7% male). Diagnoses were Marfan (32; 86.5%), Loeys-Dietz (4; 10.8%) and familial TAAA (1; 2.7%). Indications for surgery were non-dissected aneurysm (5; 13.5%), primary chronic type B dissection (23; 62.2%) and residual dissection after type A dissection repair (9; 24.3%). Twenty-eight patients (75.7%) had undergone one or more prior cardiovascular operation via median sternotomy. Two patients (5.4%) had previous abdominal aortic surgery and five had (13.5%) previous proximal DTA replacement. One case was operated on with left heart bypass and all others with full cardiopulmonary bypass. Deep hypothermic circulatory arrest was utilised in 21 cases (56.8%). Fifteen patients (40.5%) were urgent/emergency cases. There were no in-hospital deaths and no cases of spinal cord injury. One patient suffered from a stroke and one patient required temporary dialysis with subsequent recovery of renal function.
Conclusions: Patients with CTD usually present with residual dissection and open repair can be performed safely with low operative risk. TEVAR is an effective approach in more elderly patients with acquired aortic disease but may not be justified in younger patients with CTD in whom long-term results are unknown. Although less invasive, TEVAR should be carefully considered for patients with CTD and offered only when the risks of open repair are prohibitive.
Author Disclosures: M. Iafrancesco: None. A.M. Ranasinghe: None. I.J. McCafferty: None. P.J. Riley: None. M.W. Claridge: None. D.J. Adam: None. J.G. Mascaro: None.
- © 2014 by American Heart Association, Inc.