Gastrointestinal Complications after Thoracoabdominal and Descending Thoracic Aortic Repairs: a 14-years Experience

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Paul E. Achouh, MD, Ken Madsen, MD, Anthony L. Estrera, MD, Charles C. Miller, III, PhD, Ali Azizzadeh, MD, Eyal E. Porat, MD, Tam T. Huynh, MD, Jayesh J. Dhareshwar, MD, Hazim J. Safi, MD.
The University of Texas Health Science Center at Houston, Houston, TX, USA.

Objectives: Data regarding gastrointestinal (GI) complications after descending thoracic and thoracoabdominal aortic (DTA/TAA) surgical repairs is sparse. We studied the incidence, risk factors and outcomes of post-operative GI complications in our 14-year experience.
Methods: We reviewed 1053 DTAA/TAAA repairs performed between 1991 and 2005. Data was prospectively collected. The mean patient age was 68 years; 36% were female. Complications were grouped into the following categories: biliary disease, hepatic dysfunction, pancreatitis, GI bleeding, peptic ulcer disease, bowel ischemia, and ileus. GI complications were evaluated individually for impact on 30-day mortality. Risk factors for the occurrence of GI complications were ascertained by univariate and multivariable analysis.
Results: GI complications occurred in 109/1053 cases (10.3%). The incidence of GI complications and the respective associated mortalities are depicted in Table 1. Postoperative biliary disease, hepatic dysfunction and bowel ischemia were identified as life threatening complications. Risk factors for the occurrence of GI complications were abdominal extension of the aortic repair (TAA extent II, III and IV) (p=0.01; odds ratio=1.8), current smoking (p=0.03; odds ratio=2.1) and preoperative renal function assessed by glomerular filtration rate (p=0.001; odds ratio=0.9).
Conclusions: GI complications after descending thoracic and thoracoabdominal aortic surgical repairs are associated with an increased mortality. Abdominal aortic involvement and preoperative renal insufficiency are risk factors for life threatening GI complications.