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INTRODUCTION: Aortic reconstruction for complex thoracoabdominal aortic aneurysms (TAAA) can be challenging, especially in patients with connective tissue disorders (CTD) in whom tissue fragility is a major concern. Branched graft reconstruction is a more complex operation compared to inclusion patch repair of the aorta, but is frequently necessary in patients with CTD or other pathologies due to anatomic reasons. Herein, we describe our institutional experience with open branched graft reconstruction of aortic aneurysms, and compare outcomes for patients with CTD versus degenerative pathologies.
METHODS: We performed a retrospective analysis of all patients undergoing open aortic reconstruction using branched grafts at our institution between July 2006 and December 2015. Postoperative outcomes, including perioperative morbidity and mortality and long-term graft patency and the development of new aneurysms, were compared for patients with CTD vs. degenerative disease.
RESULTS: 137 patients underwent aortic repair with branched graft reconstruction during the 10-year study period. CTD patients were significantly younger (39±1.9 vs. 68±1.0 years) and had fewer comorbidities (hypertension, COPD, coronary artery disease) but a higher prevalence of aortic dissections (55% vs. 16%) and aneurysms involving the thoracic aorta (90% vs. 60%) than patients with degenerative disease (all, P>0.45). At a median follow-up time of 12.5 months (IQR 4.5, 42) months, CTD patients were more likely to develop both new aortic (20%) and non-aortic (13%) aneurysms compared to the degenerative group (6% and 4% for aortic and non-aortic aneurysms, respectively) (P=0.02). Loss of branch graft patency occurred in 0 out of 99 (0%) grafts in CTD patients and 13 out of 167 (7.8%) grafts in degenerative disease patients (P=0.004). Loss of branch graft patency occurred most commonly in left renal artery bypass grafts (77%), and was clinically asymptomatic (current creatinine 1.77±0.13 mg/dL vs. 1.41±0.25 preop, P=0.22).
CONCLUSIONS: Connective tissue disorder patients with aortic aneurysms who undergo open branched graft reconstruction have favorable outcomes compared to patients with degenerative pathology, including better branched graft patency and a similar risk of perioperative mortality and complications. Open repair of aortic aneurysms with branched graft reconstruction can be performed safely in both populations with low perioperative mortality, but ongoing surveillance is critical for the detection of new aneurysms, especially among patients with CTD.