The severity of chronic obstructive pulmonary disease is associated with adverse outcomes after open thoracoabdominal aortic aneurysm repair.

Objective: We assessed associations between outcomes after open thoracoabdominal aortic aneurysm (TAAA) repair and preoperative airflow limitation stratified by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) spirometric classification of chronic obstructive pulmonary disease (COPD) severity.
Methods: Among 2368 open elective TAAA repairs in patients with spirometric data, 1735 patients had COPD and 633 did not. Those with COPD were stratified by preoperative respiratory dysfunction as GOLD 1 (forced expiratory volume in the first second of expiration [FEV ₁ ] ≥80% of predicted; n = 228), GOLD 2 (50% ≤ FEV ₁  < 80% of predicted; n = 1215), GOLD 3 (30% ≤ FEV ₁  < 50% of predicted; n = 260), or GOLD 4 (FEV ₁  < 30% of predicted; n = 32). Early outcomes included operative mortality and adverse events (operative death or persistent stroke, spinal cord deficit, or renal failure requiring dialysis); associations of outcomes were determined using logistic regression models. Kaplan-Meier analysis compared late survival by the log-rank test.
Results: Pulmonary complications occurred in 38.4% of patients with COPD versus 30.0% without COPD (P < .001). Operative mortality and adverse events were more frequent in patients with COPD than without COPD (7.9% vs 3.8% [P < .001] and 14.9% vs 9.8% [P = .001], respectively). Worsening GOLD severity was independently associated with operative death and adverse event. Survival was poorer in patients with COPD than in those without (61.9% ± 1.2% vs 73.6% ± 1.8% at 5 years; P < .001), particularly in patients with increasing GOLD severity (68.7% ± 3.2% vs 63.7% ± 1.4% vs 51.4% ± 3.2% vs 31.3% ± 8.2% at 5 years; P < .001).
Conclusions: Patients with COPD are at elevated risk for operative death and adverse events. Staging by GOLD severity aids preoperative risk stratification. Patients with airflow limitations may benefit from optimization before TAAA repair.
Competing Interests: Conflict of Interest Statement Dr LeMaire serves as a consultant for Cerus Corporation and has served as a principal investigator for clinical studies sponsored by Terumo Aortic and CytoSorbents Corporation. Dr Coselli serves as principal investigator, consults for, and receives royalties and a departmental educational grant from Terumo Aortic; consults and participates in clinical trials for Medtronic, Inc, and W.L. Gore & Associates; and participates in clinical trials for Abbott Laboratories, CytoSorbents, Edwards Lifesciences, and Artivion. Dr Moon serves on advisory boards for Edwards Lifesciences and Medtronic, Inc. Dr Chatterjee has served on advisory boards for Edwards Lifesciences, La Jolla Pharmaceutical Company, Baxter Pharmaceuticals, and Eagle Pharmaceuticals. All other authors have nothing to disclose. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest.
(Copyright © 2023 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)