Rana MA, et al. - Researchers performed a comparison of outcomes after repair of type III and type IV thoracoabdominal aortic aneurysms (TAAAs) by threedifferent open surgical techniques at a tertiary care institution. Observations revealed that the sequential visceral branching (VB) technique had the longest duration, but it had the advantage of the shortest mesenteric and visceral ischemia times without improvement in early outcomes. The techniques were comparable regarding complications, early mortality, risk of spinal cord injury, and survival.

Methods

• Researchers performed a retrospective review of consecutive patients who underwent elective repair of type III and type IV TAAAs at their institution between 1999 and 2011.
• Based on the surgical technique, they divided patients into three groups: clamp and sew (CS), left-sided heart bypass (LHB), and visceral branching (VB) followed by aortic reconstruction.
• Early mortality and complications were assessed primarily; need for blood transfusion, duration of operation, and long-term survival were assessed secondarily.

Results

• Researchers identified 121 consecutive patients (83 men, 38 women) for this study; 52 type III and 69 type IV TAAAs who underwent elective repair (CS, 65 patients; LHB, 31 patients; VB, 25 patients).
• Eightyfour per cent used perioperative spinal drainage.
• The VB group indicated longest procedure duration (mean, 9.1 hours vs 7.7 hours and 5.7 hours for CS and LHB; P < .001), but the LHB group indicated largest transfusion requirement (mean, 3.5 L vs 1.7 L and 2.1 L for CS and VB; P=.015).
• The VB group had significantly shorter mean duration of mesenteric ischemia in comparison to CS and LHB (18 minutes vs 35 minutes for CS and 30 minutes for LHB; P < .0001).
• The groups were similar in terms of mean intensive care unit and hospital stays (9, 10, and 8 days [P=.82]; 18, 20, and 18 days [P=.76]).
• In this study, overall 30-day mortality of 6.6% was observed, this was not different between the groups (6%, 10%, and 4%; P=.68).
• At 3 and 5 years, mean follow-up was 45 ± 42 months, and actuarial overall survival was 70% and 64%, with no difference between groups (P=.36).