Keschenau PR, et al. - Researchers presented the current results of open complex aortic repair in patients with connective tissue disease (CTD). They recognized open TAA(A) repair as a durable therapy for patients with CTD. It is often performed as revision surgery, suggesting an association with relevant risks, therefore should be reserved for specialized centers. If applicable, staged procedures and thus reducing operating time should be preferred.

Methods

• Researchers performed a retrospective cross-border, single centre study.
• Seventy-two aortic operations were performed on 65 patients with CTD (41 male, median age 41 years [range 19–70 years]) from February 2000 to April 2016.
• They recognized a history of at least one aortic repair (71 open, four endovascular) in 56 patients (86%),
• Among these, 33 patients (51%) operated before at the site of the procedure reported here.
• In this study, the open procedures, counting eight emergency operations (11%), comprised of aortic arch revision (n = 1; 1%), descending thoracic aortic repair (n = 11; 15%), TAAA type I repair (n = 12; 17%), type II repair (n = 29; 40%), type III repair (n = 12; 17%), and type IV repair (n = 5; 7%).
• In two (3%) and eight cases (11%), simultaneous repair of the ascending aorta and/or the aortic arch was performed, respectively.
• Staged procedures were performed on 7 patients (10%).
• Median follow-up of 42 months (0.5–180 months) was performed.

Results

• In hospital mortality of 14% (n = 9) was evident as a result of haemorrhage (n = 3/9), neurological (n = 3/9), cardiac (n = 2/9), and pulmonary (n = 1/9) complications.
• In one (2%) and three patients (5%), paraplegia and paraparesis occurred, respectively.
• Temporary dialysis was required for 7 patients (11%); none of the patients required permanent dialysis.
• In this study, major complications were revision surgery for bleeding or haematoma (n = 20/65), sepsis (n = 10/65), myocardial infarction/severe cardiac arrhythmia (n = 2/65), stroke (n = 2/65), as well as multiorgan failure, abdominal compartment syndrome, mesenteric and peripheral ischaemia (all n = 1/65).
• As per multivariate analysis, an operating time > 7 hours (P = .006) was an independent predictor of increased mortality.
• The researchers observed that freedom from re-intervention was 85%, 1 year survival was 80%, and overall survival was 75%.