IMPACT OF PREVIOUS THORACIC ANEURYSM REPAIR ON THORACOABDOMINAL AORTIC-ANEURYSM MANAGEMENT

Background. The purpose of this study was to determine the impact of p revious thoracic aortic aneurysm repair (PTAR) on subsequent thoracoab dominal aortic aneurysm operations. Methods. A retrospective review of 723 thoracoabdominal aortic aneurysm repairs over a 10-year period fa cilitated comparison of 179 patients (24.8%) with PTAR and 544 patient s (75.2%) without PTAR. Results. Patients with PTAR had more chronic d issections and extensive thoracoabdominal aortic aneurysms, and conseq uently required longer clamp and ischemic times and more intraoperativ e transfusions. Patients without PTAR were older, had more preoperativ e comorbid disease, and had more symptomatic or ruptured aneurysms. Al though differences did not reach statistical significance, patients wi thout PTAR tended toward increased in-hospital mortality (8.5% versus 4.5%; p = 0.078) and postoperative paraplegia/paraparesis rates (6.5% versus 2.8%; p = 0.069). More patients without PTAR had cardiac compli cations (11.3% versus 5.6%; p = 0.028) and required chronic hemodialys is (5.9% versus 1.1%; p = 0.009). Conclusions. The presence of a PTAR did not adversely affect the outcome of thoracoabdominal aortic aneury sm repair. After thoracic aortic aneurysm repair, life-long radiologic surveillance and early surgical treatment are justified. (C) 1997 by The Society of Thoracic Surgeons.