The Annals of thoracic surgery · 2026
Characterizing One-Year Mortality in Early Survivors of Open Thoracoabdominal Aortic Repair.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
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Karla Anirudha, Rebello Kimberly R, Orozco-Sevilla Vincente, Nguyen Lynna, Green Susan Y, LeMaire Scott A, Chatterjee Subhasis, Moon Marc R, Coselli Joseph S
Аннотация
BACKGROUND: Although operative mortality after open thoracoabdominal aortic aneurysm (TAAA) repair is well characterized, only limited data describe 1-year survival among patients who survive the index hospitalization. This study sought to further characterize 1-year mortality among operative survivors of open TAAA repair.
METHODS: From January 1986 through July 2025, 3838 open TAAA repairs were performed within our single practice. After operative deaths and patients lacking 1-year follow-up were excluded, 3378 early survivors comprised the study cohort. Demographic, operative, and postoperative data were compared between patients who survived ≥1 year after repair and those who did not. Multivariable logistic regression was used to identify independent predictors of 1-year mortality.
RESULTS: Among early survivors, 328 (9.7%) died within 1 year. One-year mortality was associated with older age, prior percutaneous coronary intervention, prior stroke, and chronic kidney disease. Postoperative complications-namely paraplegia (odds ratio [OR] 1.96, P=.03), dialysis dependence (OR 2.00, P=.001), arrhythmia (OR 1.48, P=.01), tracheostomy (OR 2.17, P<.001), and 1-year repair failure (OR 5.13, P<.001)-independently predicted death, whereas elective repair (OR 0.57, P<.001) and discharge home (OR 0.38, P<.001) predicted 1-year survival. Model discrimination was good (C-statistic=0.77 [0.74-0.81]). Kaplan-Meier analysis showed markedly greater 1-year survival in patients initially discharged home (94%) versus elsewhere (73%; P<.001).
CONCLUSIONS: Among operative survivors of open TAAA repair, 1-year mortality remains considerable and is primarily determined by persistent postoperative complications and repair durability rather than intraoperative variables. Vigilant surveillance, structured rehabilitation, and multidisciplinary follow-up may be needed to ensure success beyond the perioperative period.
METHODS: From January 1986 through July 2025, 3838 open TAAA repairs were performed within our single practice. After operative deaths and patients lacking 1-year follow-up were excluded, 3378 early survivors comprised the study cohort. Demographic, operative, and postoperative data were compared between patients who survived ≥1 year after repair and those who did not. Multivariable logistic regression was used to identify independent predictors of 1-year mortality.
RESULTS: Among early survivors, 328 (9.7%) died within 1 year. One-year mortality was associated with older age, prior percutaneous coronary intervention, prior stroke, and chronic kidney disease. Postoperative complications-namely paraplegia (odds ratio [OR] 1.96, P=.03), dialysis dependence (OR 2.00, P=.001), arrhythmia (OR 1.48, P=.01), tracheostomy (OR 2.17, P<.001), and 1-year repair failure (OR 5.13, P<.001)-independently predicted death, whereas elective repair (OR 0.57, P<.001) and discharge home (OR 0.38, P<.001) predicted 1-year survival. Model discrimination was good (C-statistic=0.77 [0.74-0.81]). Kaplan-Meier analysis showed markedly greater 1-year survival in patients initially discharged home (94%) versus elsewhere (73%; P<.001).
CONCLUSIONS: Among operative survivors of open TAAA repair, 1-year mortality remains considerable and is primarily determined by persistent postoperative complications and repair durability rather than intraoperative variables. Vigilant surveillance, structured rehabilitation, and multidisciplinary follow-up may be needed to ensure success beyond the perioperative period.