Reoperative surgery on the thoracoabdominal aorta

Objective: Since the advent of endovascular repair for aortic aneurysms, many centers have justified the use of endovascular approaches in patients with previous open distal aortic repair by deeming these patients "high risk'' because of their previous operation. We sought to determine whether patients who undergo reoperative repair for thoracoabdominal aortic aneurysm (TAAA) have worse outcomes than patients who undergo non-reoperative repair. Methods: We reviewed our data on 3379 TAAA repairs from 1986 to 2016. We compared patients' preoperative characteristics, surgical variables, and outcomes among reoperative (n = 726) and non-reoperative (n = 2653) cases. Furthermore, we examined reoperative indications to identify repairs performed because of repair failure (n = 93) and reoperations performed as an adjacent extension of repair (n = 633). A multivariable analysis was conducted to identify predictors of adverse events by using relevant preoperative and intraoperative factors. Results: The operative mortality rate did not significantly differ between groups (8.1% for reoperative vs 7.3% for non-reoperative; P = .5); in addition, reoperative repair was not associated with an increased risk of adverse event. However, Kaplan-Meier survival analysis showed that over the first 10 years, the reoperative groups fared significantly worse than the non-reoperative group (P <. 001) (survival estimates at 10 years: 23.9% +/- 4.9% for patients with repair failure, 28.4% +/- 2.0% for those with extension of repair, and 40.1% +/- 1.1% for non-reoperative repairs). Conclusions: We were unable to detect noteworthy differences in early outcomes between reoperative and non-reoperative TAAA repair. However, mid-term results indicate worse survival for patients who undergo reoperative surgery.