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Impact of shaggy aorta on outcomes of open thoracoabdominal aortic aneurysm repair

Published:September 05, 2019DOI:https://doi.org/10.1016/j.jtcvs.2019.07.112

      Abstract

      Background

      The aim of this study was to evaluate the impact of diffuse aortic atherosclerosis–related thrombosis, or “shaggy aorta” on the outcomes of open thoracoabdominal aortic aneurysm repair (TAAA).

      Methods

      From October 1999 to March 2018, 251 patients underwent open TAAA repair using segmental-staged aortic clamping. Twenty-eight patients (11.2%) received emergent or urgent operations. Patients were classified into 3 groups: dissection aneurysm (139 patients, 55.4%), degenerative aneurysm without shaggy aorta (76 patients, 30.3%), and degenerative aneurysm with shaggy aorta (36 patients, 14.3%). Shaggy aorta was assessed using enhanced computed tomography and defined as patients with atheroma thickness ≥5 mm with irregular atheroma surface. Mean follow-up was 4.3 ± 4.1 years.

      Results

      Operative mortality was 8% (20 patients) and spinal cord injury occurred in 25 patients (10.0%), 16 of whom (6.4%) had permanent neurologic dysfunction. Operative mortality was significantly worse in patients with shaggy aorta (dissection: 2.2%, non-shaggy: 6.6%, and shaggy: 33.3%, P < .001) and shaggy aorta was a significant risk factor for spinal cord injury (dissection: 7.2%, non-shaggy: 6.6%, and shaggy: 27.8%, P < .003). Multivariable analysis demonstrated that shaggy aorta was a significant risk factor for composite outcome consisted of operative mortality, spinal cord injury, and acute renal failure (odds ratio, 4.78; 95% confidence interval, 1.91-12.3, P < .001).

      Conclusions

      Preoperative enhanced computed tomography assessment of shaggy aorta could predict high-risk patients for open TAAA repair.

      Graphical abstract

      Key Words

      Abbreviations and Acronyms:

      CI (confidence interval), CPB (cardiopulmonary bypass), CSF (cerebrospinal fluid), CT (computed tomography), ICA (intercostal artery), OR (odds ratio), SCI (spinal cord injury), SCPP (spinal cord perfusion pressure), TAAA (thoracoabdominal aortic aneurysm), TEE (transesophageal echocardiography)
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