A Quarter Century of Organ Protection in Open Thoracoabdominal Repair

Introduction:Thoracoabdominal aortic aneurysm (TAAA) remains a challenging problem. We sought to examine our experience with thoracic and thoracoabdominal aortic repairs over a 24-year period.Methods:Patient information was collected in a prospective database and analyzed retrospectively. Univariate and multivariable analysis was performed.Results:Between January 1991 and December 2014, we repaired 1896 descending thoracic (DTAA) or TAAA in 1795 patients. Mean age was 64.213.8, and 702 (37%) were women. Of 1896 operations, 646 (34.1%) were DTAA, 316 (16.7%) TAAA extent I, 310 (16.4%) TAAA extent II, 187 (9.9%) TAAA extent III, 348 (18.4%) TAAA extent IV, and 112 (5.9%) TAAA extent V. Adjunct [cerebrospinal fluid drainage (CSFD)+distal aortic perfusion (DAP)] was used in 78.4%. Mean preoperative glomerular filtration rate (GFR) was 75.1 +/- 14.9mL/min/1.73m(2). Renal dysfunction occurred in 461 (24.3%). Immediate neurodeficit (IND) occurred in 79 (4.2%) and delayed in 104 (5.5%). Of these, 47/104 (45%) recovered by discharge. Postoperative stroke was 95/1896 (5%). Early mortality was 302/1896 (15.9%). Mortality with GFR >95.3 was 28/457 (6.1%), and 131/432 (30.3%) was with GFR<48.3 (P<0.0001). Predictors of early mortality were age (P<0.02), GFR (P<0.0001), TAAA2 or 3 (P=0.001), coronary artery disease (P=0.001), and emergency (P<0.0001).Conclusions:Open DTAA and TAAA repair can be performed with acceptable early and late outcomes. This study provides important early- and long-term data on open repair, allowing for better risk stratification of patients with DTAA and TAAA. It is the high-risk subgroup that can now be targeted for endovascular techniques.