Comparison of open surgical techniques for repair of types III and IV thoracoabdominal aortic aneurysms

Objective: The objective of this study was to compare outcomes after repair of type III and type IV thoracoabdominal aortic aneurysms (TAAAs) by three different open surgical techniques at a tertiary care institution. Methods: Consecutive patients who underwent elective repair of type III and type IV TAAAs at our institution between 1999 and 2011 were retrospectively reviewed. Patients were divided into three groups according to surgical technique: clamp and sew (CS), left-sided heart bypass (LHB), and visceral branching (VB) followed by aortic reconstruction. Primary end points were early mortality and complications; secondary end points were need for blood transfusion, duration of operation, and long-term survival. Results: Between 1999 and 2011, there were 121 consecutive patients (83 men, 38 women) with 52 type III and 69 type IV TAAAs who underwent elective repair (CS, 65 patients; LHB, 31 patients; VB, 25 patients). Perioperative spinal drainage was used in 84%. Procedure duration was longest in the VB group (mean, 9.1 hours vs 7.7 hours and 5.7 hours for CS and LHB; P <.001), but transfusion requirement was largest in the LHB group (mean, 3.5 L vs 1.7 L and 2.1 L for CS and VB; P =.015). Mean duration of mesenteric ischemia was significantly shorter in the VB group vs CS and LHB (18 minutes vs 35 minutes for CS and 30 minutes for LHB; P <.0001). Mean intensive care unit and hospital stays were the same (9, 10, and 8 days [P =.82]; 18, 20, and 18 days [P =.76]). Overall 30-day mortality was 6.6%, not different between groups (6%, 10%, and 4%; P =.68). Mean follow-up was 45 ± 42 months, and actuarial overall survival at 3 and 5 years was 70% and 64%, with no difference between groups (P =.36). Conclusions: For repair of type III and type IV TAAAs, the sequential VB technique has the longest duration, but it has the advantage of the shortest mesenteric and visceral ischemia times without improvement in early outcomes. Irrespective of the techniques used, complications, early mortality, risk of spinal cord injury, and survival were the same.