Impact of Previous Thoracotomy on Outcomes of Open Thoracoabdominal Aortic Aneurysm Repair: A Retrospective Propensity Score-Matched Analysis.

Objectives

Open repair remains widely used for TAAA (Thoracoabdominal Aortic Aneurysm), but disease progression may require reoperation via repeat thoracotomy, which is technically challenging. These procedures involve increased risks due to adhesions and altered anatomy. This study aims to evaluate the impact of repeat thoracotomy on early surgical outcomes in TAAA patients.

Methods

We conducted a retrospective cohort study of 214 patients who underwent open TAAA repair between June 1996 and March 2023. Among them, 30 underwent repeat thoracotomy (RT), and 184 underwent their first thoracotomy (FT). To reduce baseline discrepancies, propensity score matching (3:1) was performed, resulting in 22 RT patients matched with 45 FT patients. The primary outcome was 30-day mortality, while secondary outcomes included postoperative complications.

Results

In the matched cohort, the median operative time was longer in the RT group (500 min, IQR [476.0-552.0]) compared to the FT group (459.0 min, IQR [426.5-514.0]; p = 0.037). Thirty-day mortality was similar between groups (RT: 4.5%, FT: 2.2%, p = 0.433). No cases of paraplegia occurred. Postoperative bleeding was observed more frequently in the RT group (RT: 13.6% vs. FT: 2.2%, p = 0.050), suggesting a potential difference, but statistical significance was not reached. Other major complications showed no significant differences.

Conclusions

In this propensity score matched analysis, repeat thoracotomy was not associated with statistically significant differences in early outcomes following open TAAA repair. These findings should be interpreted cautiously and suggest that prior left thoracotomy may not be associated with worse early outcomes in experienced centers.