Long-term Clinical Outcomes of 1020 Open Repairs of Descending Thoracic and Thoracoabdominal Aortic Aneurysms.

Objective: To assess long-term survival and operative outcomes of open descending thoracic (DTA) and thoracoabdominal (TAAA) aneurysm repair at a high-volume center.

Methods: We identified all consecutive patients undergoing DTA/TAAA repair from 1997-2023 and stratified based on aneurysm extent. Operative outcomes were assessed on univariable and multivariable analysis. Long-term survival was estimated by Kaplan-Meier method.

Results: Of 1020 patients, 273 had DTA and 747 had TAAA (53.1%, 18.5%, 20.2%, 7.6%, and 0.5% for extent I-V, respectively). Operative mortality was 4.6%; 5.1% in DTA and 4.4% in TAAA. Incidence of myocardial infarction was 0.5%, stroke 1.8%, tracheostomy 6.9%, dialysis 4.8%, and paraplegia 1.3%. On multivariable analysis, diabetes (OR 2.48[1.20-5.13];p=0.014) and renal insufficiency (OR 3.17[1.63-6.13];p<0.001) were associated with operative mortality. Among TAAA, extent II aneurysm (OR 3.56[1.59-7.96]; p=0.002) was associated with operative mortality. Median follow-up was 6.72(95% CI 5.73-7.81) years. Five- and 10-year survival were 67.2% and 48.2% for DTA and 69.9% and 47.5% for TAAA, respectively. Among TAAA, extent I was 76.4% and 49.4%, extent II 62.5% and 43.3%, extent III 60.1% and 45.6%, and extent IV 72.6% and 47.4%, respectively. Age (HR 1.04[1.02-1.05];p<0.001), COPD (HR 1.55[1.25-1.92];p<0.001), diabetes (HR 1.5[1.09-2.07];p=0.013), renal insufficiency (HR 1.47[1.18-1.85]; p<0.001), shock (HR 1.83[1.19-2.81]; p=0.006), and urgent/emergent surgery (HR 1.27[1.03-1.58]; p=0.027) were associated with long-term mortality.

Conclusions: At experienced centers, operative outcomes and long-term survival after open DTA/TAAA repair are encouraging. Short-term outcomes are dependent on preoperative risk factors and aneurysm extent. Long-term survival is dependent on age and chronic comorbidities.