Operative outcomes after open repair of descending thoracic aortic aneurysms in the era of endovascular surgery

Abstract

Background: Since the advent of endovascular techniques for repair of descending thoracic aortic aneurysms (DTAAs), there has been a relative paucity of current data for open repairs. The purpose of this study was to assess the operative and long-term outcomes in a contemporary series of open repairs of DTAAs.

Methods: We conducted a retrospective review of 68 patients (63±14.5 years) who underwent DTAA repairs between January 1999 and December 2010. Forty-two patients (62%) were male, 16 (24%) had chronic obstructive pulmonary disease, 7 (10%) required dialysis preoperatively, 11 (16%) had contained rupture, 25 (37%) had previous cardioaortic operations, and 10 (15%) had previous aortic arch replacement (stage 1 elephant trunk). The entire descending thoracic aorta was replaced in 34 patients (50%). Cardiopulmonary bypass was used in 64 patients (94%) and deep hypothermic arrest in 22 (32%).

Results: In-hospital mortality was 3% (2 patients). There was no immediate paraplegia. Delayed paraplegia developed in 1 patient (1.5%). Postoperative stroke occurred in 3 patients (4.4%), and 20 (29%) required prolonged ventilatory support (intubation≥48 hours). New-onset renal insufficiency (creatinine≥2.5 mg/dL) developed postoperatively in 6 patients (9%), and 1 (1.5%) required temporary dialysis. The median follow-up time was 5.8±3.8 years. Sixteen of the 66 operative survivors (24.2%) died during follow-up. Probability of survival was 82%±0.05% at 5 years and 67%±0.07% at 10 years. Reintervention was necessary in 4 patients (6%). Freedom from reintervention was 98%±0.02% at 5 years and 89%±0.06% at 10 years. The univariable predictor of long-term death was postoperative reintubation (p<0.05).

Conclusions: In the era of endovascular repair of DTAAs, operative death and morbidity outcomes for open repairs are observed to be low. In addition to good long-term survival rates, open repairs are durable, as evidenced by low reintervention rates.