Impact of preoperative pulmonary function on outcomes after open repair of descending and thoracoabdominal aortic aneurysms
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- 作者：Leonard N. Girardi ; MD ; lngirard@med.cornell.edu ; Christopher Lau ; MD ; Monica Munjal ; MS ; Mohamed Elsayed ; MD ; Ivancarmine Gambardella ; MD ; Lucas B. Ohmes ; MD ; Mario Gaudino ; MD
- 关键词：thoracoabdominal aortic aneurysm ; descending thoracic aortic aneurysm ; open repair ; preoperative pulmonary function ; aortic aneurysm
- 刊名：The Journal of Thoracic and Cardiovascular Surgery
- 出版年：2017
- 出版时间：February 2017
- 年：2017
- 卷：153
- 期：2
- 页码：S22-S29.e2
- 全文大小：893 K
- 卷排序：153
文摘
To evaluate the impact of preoperative pulmonary function on outcomes after open repair of descending thoracic (DTA) and thoracoabdominal aortic (TAAA) aneurysms.MethodsThe outcomes of patients undergoing open repair of DTA or TAAA were analyzed in relation to the results of preoperative pulmonary function tests. Receiver operating characteristic was adopted to assess the effect of forced expiratory volume in one second (FEV1) on the incidence of mortality. Logistic regression analysis and propensity score matching were used.ResultsBetween 1997 and 2015, 726 patients underwent open DTA or TAAA repair. Pulmonary function tests were available in 711 (97.9%). Receiver operating characteristic analysis revealed the cutoff value of FEV1 to be 50%. Propensity score matching led to 149 pairs of patients with FEV1 below and above 50% with only limited residual imbalance. In the matched population operative mortality was 11.4% and 6.0% in patients with FEV1 ≤ 50% and FEV1 ≥ 51%, respectively (P = .10). The incidence of major adverse events was 33.1% in cases with FEV1 ≤ 50% and 19.5% in those with FEV1 ≥ 51% (P = .008). FEV1 ≤ 50% was associated with a 6.99× increase in the risk of major postoperative adverse events at logistic regression analysis.ConclusionsPreoperative FEV1 < 50% is strongly predictive of increased respiratory failure, tracheostomy, and operative mortality in patients undergoing open DTA/TAAA repair. For these very high-risk patients with either extensive TAAAs or anatomy unsuitable for endovascular repair, medical therapy may offer the best long-term survival.