Long-term outcomes of extensive thoracoabdominal aortic aneurysm repair utilizing normothermic iliac perfusion: a retrospective cohort study with 10-year single-center experience

Abstract

Background: Normothermic iliac perfusion has been increasingly utilized for thoracoabdominal aortic aneurysm repair; however, the long-term outcomes in large samples are lacking. This study was designed to assess the perioperative and long-term results of thoracoabdominal aortic repair using normothermic iliac perfusion.

Methods: The authors retrospectively analyzed 156 patients having Crawford extent II or III thoracoabdominal aortic aneurysm replacement with normothermic iliac perfusion from 2012 to 2022. Primary endpoints were composite adverse events and long-term survival, which encompassed 30-day mortality, persistent stroke, persistent paraplegia, and acute renal failure needing continuous dialysis. The cohort was divided into two subgroups based on the use of selective visceral and cold renal perfusion techniques.

Results: The combined adverse event rate was 14.1%. Specific rates were: 30-day mortality (4.5%), persistent stroke (1.9%), persistent paraplegia (4.5%), and renal failure requiring persistent dialysis (3.2%). The median follow-up time was 67 months. Overall survival rates at 1, 3, 5, 7, and 10 years were 91.6, 90.0, 85.4, 77.6, and 69.7%, respectively. Subgroup analysis showed the visceral and renal perfusion group had a significantly reduced adverse event incidence compared to the nonperfusion group (6.5 vs. 19.1%, P =0.026). Multivariable logistic regression analysis confirmed selective visceral and cold renal perfusion techniques as protective factors against postoperative adverse events (OR 0.30, 95% CI: 0.09-0.94; P =0.038). Multivariable Cox regression analysis identified age ≥50 years (HR 2.63, 95% CI: 1.10-6.27; P =0.029) and NYHA grade ≥III (HR: 3.20, 95% CI: 1.04-9.87; P =0.043) as independent risk factors predicting overall survival.

Conclusions: Normothermic iliac perfusion is a feasible option for thoracoabdominal aortic repair with cost benefits and simpler management, and selective visceral and cold renal perfusion techniques may further improve its safety and effectiveness. However, enhanced vigilance and meticulous care are essential, particularly for elderly patients and those with cardiac insufficiency.

Graphical abstract

Figure 1

The distribution and frequency of diagnoses among patients who underwent TAAA repair from 2012 to 2022. TAAA, thoracoabdominal aortic aneurysm.

Figure 2

Extensive TAAA repair under contemporary normothermic iliac artery perfusion. (A) Prerepair status; (B) Proximal anastomosis; (C) Segmental artery reattachment with the applied tube technique; (D) Abdominal branch reimplantation under selective visceral and cold renal perfusion techniques; (E) Postrepair status. TAAA, thoracoabdominal aortic aneurysm.

Figure 3

Kaplan–Meier survival analysis depicting the long-term survival curves for all patients who underwent TAAA repair with normothermic iliac perfusion. Time unit in months. TAAA, thoracoabdominal aortic aneurysm.