Contemporary outcomes of open thoracoabdominal aortic aneurysm repair in the endovascular era.

Abstract

Open thoracoabdominal aortic aneurysm (TAAA) repair has been associated with high morbidity and mortality before the endovascular era, when repair options were limited. Our institution developed a multidisciplinary protocol to standardize patient selection, operative technique, and postoperative care to improve outcomes for open repairs. This study aimed to evaluate the protocol's preliminary benefits by comparing the outcomes of open TAAA repair on the protocol vs off the protocol. A retrospective review of consecutive patients who underwent TAAA repair at a single institution from 2013 to 2023 was completed. Patients who underwent open repair were included and stratified by use of the protocol. The primary outcome was a composite of TAAA life-altering events, including in-hospital mortality, spinal cord ischemia with paraplegia, new onset of dialysis, or stroke. Secondary outcomes included each individual component, length of stay, and nonhome discharge. During the study period, 220 patients underwent TAAA repair at our institution, 190 endovascular and 30 open. There were 14 in the protocol group and 16 in the nonprotocol group. Patient demographics were similar between groups with an overall mean age of 46 years. A connective tissue disorder was present in 64% and 50% (P = .431) of protocol and nonprotocol patients, respectively. The majority of the patients in both groups presented with extent II TAAA (64% vs 75%). The composite end point occurred in 0% of the protocol group vs 38% of the nonprotocol group (P = .010). Secondary outcomes were dialysis (0% vs 19%; P = .23), paraplegia (0% vs 19%; P = .232), stroke (0% vs 0%), in-hospital mortality (0% vs 13%; P = .171), and nonhome discharge (7% vs 50%; P = .012). The median postoperative length of stay was 8 days vs 15 days (P = .038). In the endovascular era, open TAAA repair can be performed with encouraging outcomes when particular attention is given to patient selection, surgical technique, and postoperative care, with rates of mortality, paraplegia, renal failure, and length of stay that rival endovascular repair.