Clinical outcome of thoracoabdominal aortic aneurysm surgical repair: preoperative predictors, intraoperative challenges, and postoperative sequelae

Background
Thoracoabdominal aortic aneurysm (TAAA) represents 10% of thoracic aneurysms and 5% of all aortic aneurysms. TAAA open surgical repair has been a challenging operation since decades, as it conjugates the pathological comorbidities of AAA and surgical challenges of TAA.
Patients and methods
A prospective cohort nonrandomized study was carried out on 20 patients with TAAA of different Crawford extents. A bad outcome was considered when mortality or irreversible morbidity that affects the patient’s lifestyle occurred. Different preoperative and intraoperative factors were correlated reciprocally with the bad outcome cases to line out the possible risk factors.
Results
The total studied cases were 20. The postoperative morbidities among the cases were chest complications (35%), cardiac morbidities (30%), renal impairment (25%), superficial surgical site infection (SSI) (25%), multiorgan system failure (10%), and paraplegia (10%). Early mortality was seen in 35% of the studied cases. The direct cause of mortality was cardiac insults (43%), chest complications (28.5%), and multiorgan system failure (28.5%). Reciprocal correlation between both preoperative predictors and intraoperative events and bad outcome group revealed a strong association between age +65 years (75% of bad outcome group), preoperative ischemic heart disease (IHD) (50%), preoperative renal impairment (37.5%), aneurysmal Crawford extent II (37.5%), ruptured aneurysm (37.5%), aneurysmal size greater than 7 cm (25%), total operative time greater than 4 h (75%), and bleeding greater than 2500 ml (50%) and bad outcome.
Conclusion
Age +65 years, preoperative cardiac and renal comorbidities, and aneurysmal extent II are the most important predictors of bad outcome. Prolonged total operative time and massive intraoperative bleeding are the most important operative challenges.