Open repair of ruptured descending thoracic and thoracoabdominal aortic aneurysms

Abstract

Objective: To evaluate the results of the open repair of ruptured thoracic and thoracoabdominal aortic aneurysms.

Methods: From January 1997, a total of 100 consecutive open repairs of ruptured thoracic or thoracoabdominal aortic aneurysms were performed (43 thoracic and 57 thoracoabdominal). These patients were compared with contemporary cases that underwent repair of corresponding intact aneurysms. Propensity matching analysis was used to neutralize the differences in baseline characteristics.

Results: Patients with ruptured aneurysm had a significantly worse baseline clinical profile. The surgical strategy adopted was similar in intact and ruptured aneurysms, with the exception of lower use of spinal drainage, intercostal reimplantation, and associated procedures in those with rupture (P < .001 for all comparisons). In the unmatched population, in-hospital mortality was 14% in the rupture group, and 4.2% in the intact group (P = .01). The incidence of postoperative myocardial infarction, need for tracheostomy, and need for dialysis was 3%, 19%, and 11% in the rupture, and 0.8%, 5.7%, and 4.2% in the intact series (P ≤ .01 for all variables). Five-year survival was 47.5% for the rupture, and 59.5% for the intact series (P < .001). In the matched population, no differences in postoperative and long-term outcome were found between the rupture and intact cases. Logistic regression analysis showed that female gender, urgent/emergent operation, and preoperative hemodialysis, but not ruptured aneurysm, were predictive of in-hospital major adverse events.

Conclusions: Open repair of ruptured thoracic and thoracoabdominal aortic aneurysms can be performed with a gratifying rate of success. For patients with similar preoperative comorbidities, postoperative survival is not affected by the presence of a ruptured aneurysm.

Keywords: aneurysm; aorta; rupture; surgery.