Diaphragm Preservation Reduces Respiratory Failure After Extent I Thoracoabdominal Aneurysm Repair

Abstract

We sought to evaluate the impact of surgical approach (thoracophrenolaparotomy vs thoracotomy crura splitting) on the outcomes of extent I thoracoabdominal aortic aneurysm repair. Patient data were extracted from our aortic surgery database. The primary endpoint was need for tracheostomy, and secondary endpoints were operative mortality, myocardial infarction, stroke, spinal cord injury, de novo dialysis, and major adverse events (composite of secondary endpoints and tracheostomy). Freedom from death and reoperation during follow-up were calculated. Risk adjustment was obtained with propensity score matching and multivariable regression. Three hundred twenty-five patients underwent extent I repair. Compared with thoracophrenolaparotomy patients (n= 226), thoracotomy crura-splitting patients (n= 99) had a higher rate of previous coronary revascularization (27.3% vs 14.2%, P=.005), valvular disease (64.6% vs 50.4%, P= .018), and chronic obstructive pulmonary disease (61.6% vs 28.3%, P= .000) and a lower forced expiratory volume in 1 second (46% vs 69%, P= .000). In a matched sample thoracotomy crura splitting was associated with a decreased need for tracheostomy (4.0% vs 13.1%, P= .035). The need for tracheostomy was predicted by female gender (odds ratio, 3.11; 95% confidence interval, 1.17-8.30; P= .023), forced expiratory volume in 1 second (odds ratio, 0.95; 95% confidence interval, 0.91-0.98; P= .003), and thoracophrenolaparotomy (odds ratio, 3.66; 95% confidence interval, 1.14-11.73; P= .029). Five-year freedom from mortality and reoperation were similar. In patients undergoing extent I thoracoabdominal aortic aneurysm repair, thoracotomy crura splitting was associated with decreased need for tracheostomy.