Pulmonary Complications After Descending Thoracic and Thoracoabdominal Aortic Aneurysm Repair

Predictors, Prevention, and Treatment

Christian D. Etz, Gabriele Di Luozzo, Ricardo Bello, Maximilian Luehr, Muhammad Z. Khan, Carol A. Bodian, Randall B. Griepp, Konstadinos A. Plestis

Research output: Contribution to journalArticle

55 Citations (Scopus)

Abstract

Background: Although recent advances in surgical techniques have improved outcomes of descending thoracic (DTA) and thoracoabdominal aortic aneurysm (TAAA) repair, significant mortality and morbidity still occur. The aim of the current retrospective study is to determine predictors of postoperative pulmonary complications and prolonged hospital stay. Methods: Two hundred nineteen patients (median age, 66 years; range, 18 to 88; 112 male) underwent DTA (n = 79 [36%; 23 elephant trunk completions]) or TAAA (n = 140 [64%; Crawford I (52%), II (10%), III (11%), IV (7%); 31 elephant trunk completions]) between June 2002 and June 2005. Forty-one patients presented with ruptured aneurysms. Left atrial-to-femoral bypass was utilized in 51% of the patients. Femorofemoral bypass and distal aortic perfusion were used in 41% of the patients, deep hypothermic circulatory arrest (DHCA) was used in 43 patients (mean duration: 31 ± 9 minutes); 8% were done with clamp-and-sew technique. Results: Adverse outcomes were seen in 21 patients (9.5%); hospital death in 13 (5.9%), and stroke in 13 (5 of whom died; 5.9%). Sixty patients (27%) experienced respiratory complications with prolonged postoperative ventilation (longer than 48 hours); 24 required tracheostomy (11%). Independent predictors of pulmonary complications after DTA/TAAA were TAAA (p = 0.03), preoperative blood urea nitrogen greater than 24 mg/dL (p = 0.03) and rupture (p = 0.09). The median hospital stay was 11 days (interquartile range, 6 to 35). Independent predictors of length of hospital stay were preoperative blood urea nitrogen (p = 0.045), postoperative bleeding (p < 0.005), reintubation (p = 0.001), tracheostomy (p < 0.0005), and transfusion of platelets (p = 0.008). Conclusions: This contemporary experience demonstrates that preoperative renal insufficiency and extensive aneurysm are important predictors of respiratory complications after aortic aneurysm surgery.

Original languageEnglish (US)
JournalAnnals of Thoracic Surgery
Volume83
Issue number2
DOIs
StatePublished - Feb 2007

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Thoracic Aortic Aneurysm
Lung
Length of Stay
Tracheostomy
Blood Urea Nitrogen
Therapeutics
Deep Hypothermia Induced Circulatory Arrest
Platelet Transfusion
Ruptured Aneurysm
Aortic Aneurysm
Thigh
Renal Insufficiency
Aneurysm
Ventilation
Rupture
Thorax
Retrospective Studies
Perfusion
Stroke
Hemorrhage

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Pulmonary Complications After Descending Thoracic and Thoracoabdominal Aortic Aneurysm Repair : Predictors, Prevention, and Treatment. / Etz, Christian D.; Di Luozzo, Gabriele; Bello, Ricardo; Luehr, Maximilian; Khan, Muhammad Z.; Bodian, Carol A.; Griepp, Randall B.; Plestis, Konstadinos A.

In: Annals of Thoracic Surgery, Vol. 83, No. 2, 02.2007.

Research output: Contribution to journalArticle

Etz, Christian D. ; Di Luozzo, Gabriele ; Bello, Ricardo ; Luehr, Maximilian ; Khan, Muhammad Z. ; Bodian, Carol A. ; Griepp, Randall B. ; Plestis, Konstadinos A. / Pulmonary Complications After Descending Thoracic and Thoracoabdominal Aortic Aneurysm Repair : Predictors, Prevention, and Treatment. In: Annals of Thoracic Surgery. 2007 ; Vol. 83, No. 2.
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abstract = "Background: Although recent advances in surgical techniques have improved outcomes of descending thoracic (DTA) and thoracoabdominal aortic aneurysm (TAAA) repair, significant mortality and morbidity still occur. The aim of the current retrospective study is to determine predictors of postoperative pulmonary complications and prolonged hospital stay. Methods: Two hundred nineteen patients (median age, 66 years; range, 18 to 88; 112 male) underwent DTA (n = 79 [36{\%}; 23 elephant trunk completions]) or TAAA (n = 140 [64{\%}; Crawford I (52{\%}), II (10{\%}), III (11{\%}), IV (7{\%}); 31 elephant trunk completions]) between June 2002 and June 2005. Forty-one patients presented with ruptured aneurysms. Left atrial-to-femoral bypass was utilized in 51{\%} of the patients. Femorofemoral bypass and distal aortic perfusion were used in 41{\%} of the patients, deep hypothermic circulatory arrest (DHCA) was used in 43 patients (mean duration: 31 ± 9 minutes); 8{\%} were done with clamp-and-sew technique. Results: Adverse outcomes were seen in 21 patients (9.5{\%}); hospital death in 13 (5.9{\%}), and stroke in 13 (5 of whom died; 5.9{\%}). Sixty patients (27{\%}) experienced respiratory complications with prolonged postoperative ventilation (longer than 48 hours); 24 required tracheostomy (11{\%}). Independent predictors of pulmonary complications after DTA/TAAA were TAAA (p = 0.03), preoperative blood urea nitrogen greater than 24 mg/dL (p = 0.03) and rupture (p = 0.09). The median hospital stay was 11 days (interquartile range, 6 to 35). Independent predictors of length of hospital stay were preoperative blood urea nitrogen (p = 0.045), postoperative bleeding (p < 0.005), reintubation (p = 0.001), tracheostomy (p < 0.0005), and transfusion of platelets (p = 0.008). Conclusions: This contemporary experience demonstrates that preoperative renal insufficiency and extensive aneurysm are important predictors of respiratory complications after aortic aneurysm surgery.",
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T1 - Pulmonary Complications After Descending Thoracic and Thoracoabdominal Aortic Aneurysm Repair

T2 - Predictors, Prevention, and Treatment

AU - Etz, Christian D.

AU - Di Luozzo, Gabriele

AU - Bello, Ricardo

AU - Luehr, Maximilian

AU - Khan, Muhammad Z.

AU - Bodian, Carol A.

AU - Griepp, Randall B.

AU - Plestis, Konstadinos A.

PY - 2007/2

Y1 - 2007/2

N2 - Background: Although recent advances in surgical techniques have improved outcomes of descending thoracic (DTA) and thoracoabdominal aortic aneurysm (TAAA) repair, significant mortality and morbidity still occur. The aim of the current retrospective study is to determine predictors of postoperative pulmonary complications and prolonged hospital stay. Methods: Two hundred nineteen patients (median age, 66 years; range, 18 to 88; 112 male) underwent DTA (n = 79 [36%; 23 elephant trunk completions]) or TAAA (n = 140 [64%; Crawford I (52%), II (10%), III (11%), IV (7%); 31 elephant trunk completions]) between June 2002 and June 2005. Forty-one patients presented with ruptured aneurysms. Left atrial-to-femoral bypass was utilized in 51% of the patients. Femorofemoral bypass and distal aortic perfusion were used in 41% of the patients, deep hypothermic circulatory arrest (DHCA) was used in 43 patients (mean duration: 31 ± 9 minutes); 8% were done with clamp-and-sew technique. Results: Adverse outcomes were seen in 21 patients (9.5%); hospital death in 13 (5.9%), and stroke in 13 (5 of whom died; 5.9%). Sixty patients (27%) experienced respiratory complications with prolonged postoperative ventilation (longer than 48 hours); 24 required tracheostomy (11%). Independent predictors of pulmonary complications after DTA/TAAA were TAAA (p = 0.03), preoperative blood urea nitrogen greater than 24 mg/dL (p = 0.03) and rupture (p = 0.09). The median hospital stay was 11 days (interquartile range, 6 to 35). Independent predictors of length of hospital stay were preoperative blood urea nitrogen (p = 0.045), postoperative bleeding (p < 0.005), reintubation (p = 0.001), tracheostomy (p < 0.0005), and transfusion of platelets (p = 0.008). Conclusions: This contemporary experience demonstrates that preoperative renal insufficiency and extensive aneurysm are important predictors of respiratory complications after aortic aneurysm surgery.

AB - Background: Although recent advances in surgical techniques have improved outcomes of descending thoracic (DTA) and thoracoabdominal aortic aneurysm (TAAA) repair, significant mortality and morbidity still occur. The aim of the current retrospective study is to determine predictors of postoperative pulmonary complications and prolonged hospital stay. Methods: Two hundred nineteen patients (median age, 66 years; range, 18 to 88; 112 male) underwent DTA (n = 79 [36%; 23 elephant trunk completions]) or TAAA (n = 140 [64%; Crawford I (52%), II (10%), III (11%), IV (7%); 31 elephant trunk completions]) between June 2002 and June 2005. Forty-one patients presented with ruptured aneurysms. Left atrial-to-femoral bypass was utilized in 51% of the patients. Femorofemoral bypass and distal aortic perfusion were used in 41% of the patients, deep hypothermic circulatory arrest (DHCA) was used in 43 patients (mean duration: 31 ± 9 minutes); 8% were done with clamp-and-sew technique. Results: Adverse outcomes were seen in 21 patients (9.5%); hospital death in 13 (5.9%), and stroke in 13 (5 of whom died; 5.9%). Sixty patients (27%) experienced respiratory complications with prolonged postoperative ventilation (longer than 48 hours); 24 required tracheostomy (11%). Independent predictors of pulmonary complications after DTA/TAAA were TAAA (p = 0.03), preoperative blood urea nitrogen greater than 24 mg/dL (p = 0.03) and rupture (p = 0.09). The median hospital stay was 11 days (interquartile range, 6 to 35). Independent predictors of length of hospital stay were preoperative blood urea nitrogen (p = 0.045), postoperative bleeding (p < 0.005), reintubation (p = 0.001), tracheostomy (p < 0.0005), and transfusion of platelets (p = 0.008). Conclusions: This contemporary experience demonstrates that preoperative renal insufficiency and extensive aneurysm are important predictors of respiratory complications after aortic aneurysm surgery.

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