OUR RESULTS
Our study included 219 patients who underwent TAA repair (n = 79; 36%; 23 procedures were elephant trunk completions) and TAAA repair (n = 140; 64%) between June 2002 and June 2005 at Mt Sinai Hospital (130 procedures) and Montefiore Hospital (89 procedures), both in New York, New York. The mean age of the patients was 63.8 years (range, 18-88 years). Preoperative risk factors included a history of hypertension (212 patients), a history of smoking (110), COPD (53), a history of cerebrovascular accident (34), chronic renal insufficiency (27, 8 of whom required preoperative hemodialysis), and insulin-dependent diabetes mellitus (24). In all, 144 patients underwent elective surgery because of enlargement of a known aneurysm, 34 patients had urgent surgery, and 41 patients underwent emergent repairs because of rupture. Fifty-two percent of the TAAAs were classified as Crawford I, 10% were Crawford II, 11% were Crawford III, and 7% were Crawford IV.
Four patients developed postoperative paraplegia. Postoperative MI occurred in five patients, and 13 patients suffered a postoperative stroke. Sixty patients experienced respiratory complications with prolonged postoperative ventilation (longer than 48 hours); 24 patients required a tracheostomy. Eight patients had acute renal failure requiring postoperative dialysis; Table: Postoperative complications and hospital stay, stratified by institution (in the online version of this article) summarizes our results. Mortality rates were 5.1% (4 of 79) for TAA repair and 6.4% (9 of 140) for TAAA repair.
CONCLUSION
Surgical repair of TAAs and TAAAs can achieve acceptable mortality and morbidity outcomes when a multidisciplinary approach to surgery and posteroperative care is used. Organspecifi c protective measures should be used to prevent postoperative complications. In addition, using specific variables to calculate the risk of rupture can identify those patients who will derive the most benefit from undergoing extensive repair procedures. JAAPA
Debra Kleinschmidt works at New York Presbyterian Hospital, Weill Cornell Department of Transplant Surgery in New York, New York. She practiced in cardiothoracic surgery at Lenox Hill Hospital at the time this article was written. Konstadinos Plestis is a cardiothoracic surgeon at Lenox Hill Hospital, New York, New York. Panagiotis Housits was a fellow in cardiothoracic surgery at Mt Sinai Hospital, New York, New York at the time this article was written. The authors have indicated no relationships to disclose relating to the content of this article.
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