Contemporary outcomes of open thoraco-abdominal aortic repair: a single-centre experience

OBJECTIVES Untreated cases of thoraco-abdominal aortic aneurysms pose significant challenges, often leading to severe morbidity and high mortality. While promising, endovascular treatment is not suitable in all cases, particularly younger patients and those with collagen disorders. This study reports on the contemporary outcomes of open thoraco-abdominal aortic aneurysm repair at our academic medical centre from 2015 to 2023.METHODS All patients with thoraco-abdominal aortic aneurysm (Crawford-Safi Types I-V), including elective and non-elective cases, who underwent open surgical repair between January 2015 and December 2023 were included. Patient characteristics, intraoperative variables and postoperative outcomes were prospectively recorded and analysed retrospectively. The primary end point was operative mortality; secondary end points included rates for spinal cord injury, stroke, tracheostomy, need for dialysis and a comparison of outcomes between elective and non-elective cases.RESULTS 190 patients (146 elective/44 non-elective) were included, with a mean age of 63.8 years (standard deviation 11.5), and 58% were male. Operative mortality was 7.9%, with 7.5% in elective cases and 9.1% in non-elective cases. Stroke with persisting symptoms at discharge occurred in 5.8% of patients, and tracheostomy was required in 3.7%. Spinal cord injury symptoms were observed in 7.4%, with persistent paraparesis in 2.1% and paraplegia in 1.6% at discharge. Acute kidney injury occurred in 38.4% of patients, with 6.9% requiring dialysis and 3.7% continuing dialysis at discharge.CONCLUSIONS Open thoraco-abdominal aortic aneurysm surgery, supported by a multidisciplinary team approach and strict perioperative protocols, remains effective in managing this complex patient population, demonstrating low rates of mortality and severe complications. Surgical management of the pathologic thoraco-abdominal aorta, mainly due to degenerative or post-dissection aneurysms, poses formidable challenges.