William Frankel, Dr. Howard K Song, Dr. Rita K Milewski, Dr. Sherene Shalhub, Ms. Norma L Pugh, Dr. Kim A Eagle, Dr. Mary J Roman, Dr. Reed E Pyeritz, Dr. Cheryl L Maslen, Dr. William J Ravekes, Dr. Joseph S Coselli, Dr. Scott A LeMaire
Baylor College of Medicine
Background: Although patients with various types of heritable aortopathy often require distal aortic repair, data are limited regarding the most extensive operations—open thoracoabdominal aortic aneurysm (TAAA) repairs. The objective of this multicenter registry study was to characterize TAAA repairs in a large cohort of patients with different heritable aortic diseases.
Methods: From the 3,671 patients enrolled at 8 participating centers in the Genetically Triggered Thoracic Aortic Aneurysms and Cardiovascular Conditions (GenTAC) Registry, we identified 155 open TAAA repairs in 142 unique patients. We examined data related to clinical characteristics, surgical techniques, and outcomes.
Results: The primary diagnoses included Marfan syndrome (n=76; 54%), familial thoracic aortic aneurysm and dissections (FTAAD) (n=31; 22%), and Loeys-Dietz syndrome (n=10; 7%). Most repairs were performed for aneurysms associated with aortic dissection (n=110; 71%). The most common repairs involved the entire descending thoracic aorta with distal extension (21% Crawford extent I and 36% extent II). Adjuncts used during repair varied substantially. The operative mortality rate was 1.3%. Other complications included paraplegia (4%), acute renal failure (5%), stroke (2%), and vocal cord paralysis (21%). Reoperation after TAAA repair was required in a subset of cases for early bleeding (n=15; 10%) and late repair failure (n=7; 5%).
Conclusions: Open TAAA repairs are necessary in a variety of heritable aortic diseases. These patients often require extensive surgical repair, and a variety of adjunctive techniques are employed. The need for reoperation is common, and the risk of repair failure supports the need for vigilant long-term surveillance after repair.