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OBJECTIVES To compare short-term outcomes, long-term survival and reinterventions in patients requiring surgery after chronic Type I and chronic primary Type III aortic dissections. METHODS Over an 11-year period, 466 patients underwent thoraco-abdominal aortic aneurysm repair for chronic Type III (n  = 239) and Type I (n  = 227) aortic dissections. Short-term outcomes and reinterventions were evaluated by multivariable regression analysis for the entire group; propensity matching produced 169 pairs. RESULTS Mortality was 6% (n  = 28) in the overall cohort and 6.2% (n  = 14) and 5.9% (n  = 14) in those with chronic Type I and Type III aortic dissections, respectively. Overall stroke and persistent spinal cord deficit rates were 4.0% and 2.6%, respectively, in the Type I group and 1.3% and 3.8% in the Type III group. In the propensity-matched patients, analysis showed no neurological differences between the 2 groups, but respiratory failure was significantly more frequent in the chronic Type I group (30.2% vs 15.4%; P  =   0.001). Multivariable analysis identified chronic Type I dissection as an independent risk factor for postoperative pulmonary complications (odds ratio 1.612; 95% confidence interval 1.060–2.452; P  =   0.026) and an association between chronic Type I dissection and stroke (odds ratio 4.013; 95% confidence interval 1.026–15.698; P  =   0.046). Six-year survival was 74.4%   ±   4.1% and 74.4%   ±   4.6% in the chronic Type I and Type III groups, respectively (P  =   0.87). CONCLUSIONS Short- and long-term mortality and reintervention rates were comparable after open repair for chronic Type I and primary chronic Type III aortic dissections. Respiratory failure was more frequent in the chronic Type I aortic dissection group. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To evaluate surgical outcomes in open repair of thoracoabdominal aortic (TAAA) and descending thoracic aortic aneurysms (DTA) in patients with preoperative renal failure (PRF). METHODS: Our database was examined for all patients undergoing open TAAA/DTA repair. Patients with a creatinine greater than or equal to 1.5 gm/dl or on haemodialysis were defined as having PRF and were compared to those having normal preoperative renal function. Logistic and Cox regression analysis were used to identify independent determinants of in-hospital outcomes and long-term survival. RESULTS: From 1997 to 2015, 711 patients underwent open TAAA/DTA repair. Two hundred and two were categorized as having PRF, of which, 22 where on preoperative haemodialysis. PRF patients had significantly worse comorbidities; smoking (95.5% vs 69.0%; P < 0.001), chronic pulmonary disease (65.8% vs 29.7%; P < 0.001), peripheral vascular disease (44.1% vs 19.4%; P < 0.001) and diabetes (16.3% vs 6.7%; vs P < 0.001). Operative mortality (OM) was seven-times higher in patients with PRF (14.2 vs 2.2%; P < 0.001). Logistic regression analysis showed that PRF was a predictor of OM [odds ratio (OR): 4.91; confidence interval (CI): 2.01–11.97; P < 0.001] and major adverse events (OR: 2.05; CI: 1.21–3.46; P = 0.007). Kaplan–Meier 5-years survival was significantly lower in PRF patients (45.0% vs 69.8%; P < 0.001). CONCLUSIONS: PRF predicts higher OM and major adverse events incidence following open TAAA/DTA repair. Long-term survival is negatively impacted. Strategies for improving preoperative and intraoperative renal function may lead to better outcomes. [ABSTRACT FROM AUTHOR]