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Aortic Aneurysm Repair

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I am a long-term cancer survivor. I developed chemotherapy-induced cardiomyopathy in late 2010 . Since then I began undergoing annual echocardiograms.  I have noticed both my aortic root and my descending aorta growing a bit each year or two. As if my health situation weren’t complicated enough, a geneticist recently told me that he believes I have Marfan Syndrome. I’m wondering aortic aneurysm repair is in my future.

So I’m researching and writing about open heart surgery. As you can read from the information below, there are definitely risks to surgery to repair the heart.

Like the article linked below explains, the decision to undergo aortic aneurysm repair is a risk/reward decision.

My risks are many. The main benefit is that I don’t have an aortic dissection. This is when your aorta splits open. Few people live when this happens.


What are the risks of an open heart aortic aneurysm repair?

  • Bleeding: Significant blood loss during surgery is common, which may require blood transfusions.
  • Infection: There is a risk of infection at the incision site, within the chest cavity, or in other areas of the body.
  • Heart Attack: The stress of surgery can cause a heart attack, especially in patients with existing heart disease.
  • Stroke: Blood clots or air bubbles that travel to the brain can cause a stroke.
  • Respiratory Complications: Problems such as pneumonia or difficulty breathing can occur, particularly in patients with preexisting lung conditions.
  • Kidney Damage: The kidneys may be affected by the changes in blood flow during surgery, leading to temporary or permanent kidney problems.
  • Spinal Cord Injury: There is a risk of spinal cord injury which can lead to paralysis, especially in surgeries involving the descending thoracic or thoracoabdominal aorta.
  • Arrhythmias: Irregular heartbeats can occur, sometimes necessitating medication or further interventions.
  • Graft Complications: The artificial graft used to repair the aneurysm can become infected, or it might fail or leak.
  • Long-term Survival and Quality of Life: Recovery can be prolonged and challenging, and long-term survival rates vary depending on individual circumstances and the success of the surgery.
  • Reoperation: Some patients may require additional surgeries if complications arise or if the aneurysm recurs.

As of today, the spring of 2024, my descending aorta is enlarged but only modestly. Meaning that I am not under any pressure to undergo aortic aneurysm repair. Unfortunately I cannot say the same about my aortic root enlargement…

Are you a cancer survivor grappling with chemotherapy-induced cardiomyopathy? Do you wonder if open heart surgery is in your future?

I manage my heart-health daily with a number of-

  • heart-healthy supplements,
  • heart-healthy nutrition, and
  • heart healthy lifestyle therapies such as daily, moderate exercise. 

David Emerson

  • Cancer Survivor
  • Cancer Coach
  • Director PeopleBearingCancer

Comparison of various functional assessment tools to identify older patients undergoing aortic aneurysm repair at risk for postoperative complications

“Background- To estimate whether the benefits of aortic aneurysm repair will outweigh the risks, determining individual risks is essential. This single-center prospective cohort study aimed to compare the association of functional tools with postoperative complications in older patients undergoing aortic aneurysm repair.

Methods- Ninety-eight patients (≥ 65 years) who underwent aortic aneurysm repair were included. Four functional tools were administered: the Montreal Cognitive Assessment (MoCA); the 4-Meter Walk Test (4-MWT); handgrip strength; and the Groningen Frailty Indicator (GFI). Primary outcome was the association between all tests and 30-day postoperative complications.

Results- After adjusting for confounders, the OR for MoCA was 1.39 (95% CI 0.450;3.157; P=0.723), for 4-MWT 0.63 (95% CI 0.242;1.650; P=0.348), for GFI 1.82 (95% CI 0.783;4.323, P=0.162), and for weak handgrip strength 4.78 (95% CI 1.338;17.096, P=0.016).

Conclusion- Weak handgrip strength is significantly associated with the development of postoperative complications after aortic aneurysm repair. This study strengthens the idea that implementing a quick screening tool for risk assessment at the outpatient clinic, such as handgrip strength, identifies patients who may benefit from preoperative enhancement with help from, for example, Comprehensive Geriatric Assessment, eventually leading to better outcomes for this patient group…

Frailty is a multi-domain and dynamic geriatric condition that could explain variability in biological aging.3 Due to frailty, older surgical patients are at an increased risk of developing postoperative complications and are prone to become more frail postoperatively.

In aortic aneurysm patients this risk is even higher since aneurysm biology is a focal representation of a systemic disease of the vasculature, i.e. atherosclerosis, affecting various vascular beds and organs.1,4

Second, the consideration between individualized surgical risk versus benefit assessment is important since the surgical treatment is in the context of prevention (e.g. preventing aneurysm rupture). To estimate if the benefits will outweigh the risks, determining and diminishing individual risks is essential to improve outcomes.5

Over the past years, many frailty and/or surgical risk assessment tools have been developed for this patient group, but few have been clinically implemented, with no consent for a gold standard.6,7

Therefore, the aim of this study was to compare the association of various functional assessment tools with postoperative complications in older vascular surgery patients undergoing aortic aneurysm repair…

3.2. Postoperative outcomes

The median length of hospital stay was 5 days (IQR 4-8), with 10 days (IQR 8-14) for the patients that underwent open repair and 5 days (IQR 4-8) for the patients that underwent endovascular repair (P=<0.001) (Table 2).

Most patients were discharged home (91.8%). Seventeen patients (54.8%) that underwent open repair developed one or more postoperative complications, and 16 patients (23.9%) that underwent endovascular repair (P=0.003). During their hospital stay, 9 patients (9.2%) developed postoperative delirium, of which 7 underwent open (22.6%) and 2 patients endovascular repair (3.0%). The total 30-day readmission rate was 7.1% (n=7). The breakdown of the postoperative complications by organ system per Clavien Dindo grade is shown in Supplemental Table 1…”

 

 

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