Open surgical thoracoabdominal aortic aneurysm repair: The Heidelberg experience

Abstract

Objective: Open surgical repair of thoracoabdominal aortic aneurysm remains an important treatment option and continues to be challenging. The objective of this study was to investigate the results after open repair of thoracoabdominal aortic aneurysms in a contemporary non-high-volume center collective.

Methods: A total of 38 patients underwent operation for thoracoabdominal aortic aneurysm between August 2007 and April 2017. Patients had aortic aneurysm and chronic aortic dissection. The majority of patients had already undergone previous aortic interventions.

Results: The mean age was 54.4 ± 13.4 years (range, 29-72.5 years), and 22 patients (57.9%) were female. Most commonly, patients (57.9%) presented with Crawford type II aneurysms. The mean cardiopulmonary bypass time was 159 ± 65 minutes. The operative mortality was 10.5% (n = 4). The paraplegia rate and the incidence of stroke were 7.9% (n = 3). Postoperatively, 4 patients (10.5%) required temporary hemodialysis. In 4 patients (10.5%), reexploration due to bleeding was necessary. Sepsis developed in 4 patients (10.5%). Preoperative renal insufficiency was identified as a predictor of mortality. The patients were discharged from the hospital after a median length of stay of 21.5 days. The 1-year survival was 83%.

Conclusions: Despite the invasiveness of open thoracoabdominal aortic repair and significant risk of major complications, surgical repair can be accomplished in a non-high-volume center with acceptable results.

Keywords: early mortality; open repair; outcomes; thoracoabdominal aneurysm.