# Impact of Previous Thoracotomy on Outcomes of Open Thoracoabdominal Aortic Aneurysm Repair: A Retrospective Propensity Score-Matched Analysis

## TL;DR

This study finds that repeat thoracotomy for aortic aneurysm repair does not significantly worsen early surgical outcomes compared to first-time procedures.

## Contribution

The study provides evidence that repeat thoracotomy for TAAA repair is not associated with worse early outcomes in experienced centers.

## Key findings

- Repeat thoracotomy had longer operative times but similar 30-day mortality compared to first-time thoracotomy.
- Postoperative bleeding was more frequent in the repeat thoracotomy group, though not statistically significant.
- No cases of paraplegia occurred, and other major complications were similar between groups.

## Abstract

Objectives: Open repair remains widely used for TAAA (Thoracoabdominal Aortic Aneurysm), but disease progression may require reoperation via repeat thoracotomy, which is technically challenging. These procedures involve increased risks due to adhesions and altered anatomy. This study aims to evaluate the impact of repeat thoracotomy on early surgical outcomes in TAAA patients. Methods: We conducted a retrospective cohort study of 214 patients who underwent open TAAA repair between June 1996 and March 2023. Among them, 30 underwent repeat thoracotomy (RT), and 184 underwent their first thoracotomy (FT). To reduce baseline discrepancies, propensity score matching (3:1) was performed, resulting in 22 RT patients matched with 45 FT patients. The primary outcome was 30-day mortality, while secondary outcomes included postoperative complications. Results: In the matched cohort, the median operative time was longer in the RT group (500 min, IQR [476.0–552.0]) compared to the FT group (459.0 min, IQR [426.5–514.0]; p = 0.037). Thirty-day mortality was similar between groups (RT: 4.5%, FT: 2.2%, p = 0.433). No cases of paraplegia occurred. Postoperative bleeding was observed more frequently in the RT group (RT: 13.6% vs. FT: 2.2%, p = 0.050), suggesting a potential difference, but statistical significance was not reached. Other major complications showed no significant differences. Conclusions: In this propensity score matched analysis, repeat thoracotomy was not associated with statistically significant differences in early outcomes following open TAAA repair. These findings should be interpreted cautiously and suggest that prior left thoracotomy may not be associated with worse early outcomes in experienced centers.