Open surgical repair of 2286 thoracoabdominal aortic aneurysms

Background. As endovascular approaches to thoracoabdominal aortic repairs continue to evolve, careful assessment of the safety and efficacy of these alternative approaches will require comparison with standard open surgical repair. The purpose of this report is to update our experience with conventional open repair of thoracoabdominal aortic aneurysms. Methods. Since 1986, 2286 patients have undergone open repair of thoracoabdominal aortic aneurysms on our service. Of these, 1662 patients (72.7%) had degenerative aneurysms without dissection, 78 (3.4%) had acute aortic dissection, and 546 (23.9%) had chronic dissection. There were 139 ruptured aneurysms (6.1%). Extensive repairs (ie, Crawford extents I and II) were performed in 1468 patients (64.2%). Segmental intercostal or lumbar arteries were reattached in 1401 patients (61.3%), left heart bypass was used in 909 (39.8%), and cerebrospinal fluid drainage was used in 615 (26.9%). Results. The 30-day survival rate was 95.0% (2171 patients). Renal failure requiring hemodialysis occurred in 129 patients (5.6%), and paraplegia or paraparesis developed in 87 patients (3.8%). Patients who underwent replacement of the entire thoracoabdominal aorta (extent II) had the highest rates of death (6.0%), spinal cord deficit (6.3%), and renal failure (8.3%). Conclusions. Current management strategies enable patients to undergo conventional open thoracoabdominal aortic aneurysm repair with excellent early survival and acceptable morbidity.