Evaluating normothermic artery bypass and visceral-anastomosis-first strategy in thoracoabdominal aortic aneurysm repair: propensity-weighted analysis.

Abstract

Objective: To assess the effectiveness and safety of a normothermic artery bypass and visceral-anastomosis-first (NABV) strategy for thoracoabdominal aortic aneurysm repair.

Methods: From July 2017 to September 2024, a retrospective analysis was conducted on early postoperative complications in two groups of patients undergoing thoracoabdominal aortic aneurysm repair. The analysis compared patients treated with a new strategy with those treated with deep hypothermic circulatory arrest, clarifying the protective effects of the new strategy on visceral organs, particularly the spinal cord.

Results: A total of 182 patients were included in the study; 73 in the NABV group and 109 in the DHCA group. After inverse probability of treatment weighting, the NABV group had lower incidences of spinal cord deficit, pulmonary complications, and gastrointestinal insufficiency, a shorter duration of mechanical ventilation, and a shorter hospital stay. Body mass index ≥ 24.0 (odds ratio 3.099, 95% confidence interval (c.i.) 1.051 to 9.142; P = 0.004) and coronary artery disease (odds ratio 4.848, 95% c.i. 1.169 to 20.102; P = 0.030) were independent risk factors for spinal cord deficit in the entire cohort, in contrast to the NABV strategy (odds ratio 0.283, 95% c.i. 0.039 to 0.806; P = 0.025), which was a protective factor. The multivariable Cox regression analyses identified smoking history (hazard ratio 2.61, 95% c.i. 1.12 to 6.05; P = 0.026) as an independent risk factor for overall survival.

Conclusion: The treatment of thoracoabdominal aortic aneurysm through open surgery is still an important method and remains difficult. The NABV strategy, as a safe and reproducible technique, minimizes the risk of complications associated with spinal cord injury when implemented at experienced medical centres. To better evaluate the clinical outcomes of this surgical approach, long-term follow-up and further prospective cohort studies are necessary.