Early outcomes for women and men after open extent III thoracoabdominal aortic aneurysm repair.

Abstract

Crawford extent III thoracoabdominal aortic aneurysm (TAAA) repairs, which extend from the lower descending thoracic aorta (below the sixth rib) into the abdomen, may be perceived as less morbid than extent II TAAA repairs that begin near the left subclavian artery. In contemporary repair, there is a relatively high risk. We aimed to identify predictors of major complications after open extent III TAAA repair and explore differences between men and women. In this retrospective study, 732 patients (median age, 69 years; quartile 1-quartile 3, 61-74 years) who underwent extent III repair between 1990 and 2021 were stratified by sex (306 women [41.8%] and 426 men [58.2%]). Statistical models identified independent predictors of operative mortality and adverse events (comprising operative death or persistent stroke, paraplegia, paraparesis, or renal failure). Inverse probability of treatment weighting analysis was done to eliminate baseline differences between groups when the primary outcomes were assessed. Competing risk analyses compared relative rates of survival and freedom from repair failure between men and women. Operative mortality was 8.7% (women 10.8% vs men 7.3%; P = .1), and adverse events occurred in 16.8% of patients (women 20.6% vs men 14.1%; P = .02). Predictors of operative mortality were female sex, a larger maximal aortic diameter, chronic kidney disease, chronic symptoms, longer cross-clamp time, and more packed red blood cell units transfused. Independent predictors of adverse events were female sex, chronic kidney disease, longer cross-clamp time, branch vessel stenting, and more packed red blood cell units transfused. Elective operation predicted better operative survival and fewer adverse events than urgent or emergency repairs. Weighted analysis (inverse probability of treatment weighting adjustment) showed that female sex was independently predictive of adverse events (odds ratio, 1.75; 95% confidence interval, 1.09-2.80; P = .02). Women and men did not differ significantly in late survival (P = .3) or freedom from repair failure (P > .9). Open extent III repair remains a durable approach for TAAA repair but carries a notable risk of operative mortality and adverse events. Female sex independently predicts adverse events after weighting; however, long-term survival is comparable between men and women. These insights into the extent III repair patient population could be used to revise treatment guidelines and, thus, to improve patient outcomes.