Early and late outcomes of open repair for dissecting aneurysms of the descending or thoraco-abdominal aorta.

Abstract

Although open repair is the standard surgical option for dissecting descending thoracic aneurysms (DTAs) and thoraco-abdominal aorta aneurysms (TAAAs), it remains a significant challenge with considerable perioperative morbidity and mortality. We retrospectively analysed early and late outcomes of open repair for these aortic aneurysms. Early and late outcomes were investigated for 223 consecutive patients who underwent open repair for dissecting DTA or TAAA between January 2003 and December 2014 (mean age 55 ± 16 years). The basic strategy for open surgery comprised liberal use of deep hypothermia and aggressive preservation or reattachment of intercostal arteries, i.e. donor arteries for the artery of Adamkiewicz. Deep hypothermia was used in 150 (67.3%) patients. The overall in-hospital mortality rate was 3.6% and 1.5% for elective cases. The rates of spinal cord ischaemic injury and stroke were 3.1% and 4.5%, respectively. During follow-up (mean 63 ± 40 months), overall 5-year survival rates was 89.2 ± 2.4% and 91.3 ± 2.8% and 86.3 ± 4.1% for DTA and TAAA, respectively. Five- and 10-year rates of freedom from aortic events, defined as surgery for initial operation-related events or for downstream aortic dilation, were 89.1 ± 3.5% and 68.2 ± 7.8% for DTA and 100% and 96.6 ± 3.4% for TAAA, respectively (P < 0.01). Our approach in treating this aortic pathology showed favourable early and long-term outcomes with acceptable neurological complication rates. More careful follow-up is necessary in patients with DTA repair, because downstream aortic enlargement occurs in some patients.