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Long-term Outcomes Of Open Thoracoabdominal Aortic Repair In Connective Tissue Disease Patients: A 12-years Institutional Experience
Abdul Kader Natour, M.D., Alberto Pochettino, M.D., Manju Kalra, MBBS, Randall DeMartino, M.D., Jill Colglazier, M.D..
Mayo Clinic, Rochester, MN, USA.
OBJECTIVES: Long-term outcome data on open aortic repair in patients with connective tissue disease (CTD) remain limited. This study aims to evaluate the short- and long-term outcomes of open thoracoabdominal aortic repair (OTAAR) in this patient population.
METHODS: Retrospective single-institutional review of patients who underwent extent I-V OTAAR between 2013 and 2025. Patients with clinically or genetically diagnosed CTD were included in the study. The primary outcomes were 30-day and 1-year mortality. Secondary outcomes included neurologic, renal, cardiac, and pulmonary complications, visceral ischemia, long-term branch-graft patency, graft-related complications, and survival.
RESULTS: Among 146 patients who underwent OTAAR during the study period, 56 had CTD and were included in the analysis. Average age was 42±12 years, and 68% (n=38) were male. Most of the patients were diagnosed with Marfan (68%, n=38), followed by Loeys-Dietz syndrome (14%, n=8) (
Table 1). Most repairs were done electively for post-dissection aneurysms (91%, n=51) requiring extent II thoracoabdominal aortic repair (68%, n=38). Visceral and/or renal artery reconstructions were performed in nearly all patients (96%, n=54). Most patients had prior aortic surgery performed (89%, n=50). The 30-day mortality was 2% (n=1), with one patient dying intraoperatively secondary to failure to wean from cardiopulmonary bypass. The 1-year mortality was 5% (n=3). Prolonged ventilator support >48 hours occurred in 4 patients (7%) with only 2 patients (4%) requiring tracheostomy placement. Visceral ischemia occurred in 4 patients, with 3 (5%) being graft-related. One patient (2%) had spinal cord ischemia with paraparesis, and 2 (4%) had renal failure requiring permanent dialysis. At a mean imaging follow-up time of 59 ±48 months, the primary patency of the celiac, superior mesenteric, left renal and right renal arteries were 98%, 100%, 100%, and 94%, respectively. Graft-related complications were mainly secondary to intercostal patch aneurysms, which occurred in 8 patients (15%), 5 of whom necessitated endovascular repair (
Table 1). At a mean follow-up of 68 ±47 months, the survival of operated cohort was 89%.
CONCLUSIONS: Open thoracoabdominal aortic repair in CTD patients can be performed safely with good short- and long-term outcomes. Ongoing surveillance is critical in detecting graft related complications, especially intercostal patch aneurysms.
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