title: Open repair of thoracoabdominal aortic aneurysm in the modern surgical era: contemporary outcomes in 509 patients.
abstract: BACKGROUND
  Recent technologic advances in endovascular devices have led to alternative approaches to thoracoabdominal aortic aneurysm (TAAA) repair; these innovative approaches must be compared with the "gold standard" of conventional open TAAA repair. To facilitate such comparisons, we evaluated contemporary outcomes of open TAAA repair.
  
  
  METHODS
  We retrospectively reviewed and analyzed data collected prospectively between May 2006 and October 2010 regarding 509 consecutive patients who underwent TAAA repair. Standard univariate statistical comparisons were performed, as well as multivariable modeling, to identify predictors of survival.
  
  
  RESULTS
  A total of 305 patients (59.9%) had degenerative aneurysms without dissection, and 204 (40.1%) had aortic dissection. There were 104 (20.4%) urgent or emergent repairs and 26 (5.1%) ruptured aneurysms. Operative adjuncts were used selectively. Of the 290 patients (57.0%) who underwent extensive repairs (Crawford extents I and II), 282 (97.2%) had cerebrospinal fluid drainage, 257 (88.6%) had left heart bypass, and 213 (73.4%) had intercostal/lumbar artery reattachment. The overall operative survival rate was 92.1% (469 of 509), and survival was better after elective repairs (93.8% [380 of 405]) than after urgent or emergent operations (85.6% [89 of 104], p = 0.005). Renal failure necessitating hemodialysis at discharge developed in 30 patients (5.9%). Permanent paraplegia occurred in 13 patients (2.6%). Actuarial survival was 79.1% ± 2.0% at 2 years.
  
  
  CONCLUSIONS
  Contemporary open TAAA repair is characterized by respectable early outcomes, particularly when repair is elective. Such results should be compared with those of evolving approaches, including endovascular and hybrid repairs.
authors.affiliation: University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Wong
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Parenti
authors.forename: Susan Y
authors.initials: SY
authors.lastname: Green
authors.forename: Varun
authors.initials: V
authors.lastname: Chowdhary
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Liao
authors.forename: Samantha
authors.initials: S
authors.lastname: Zarda
authors.forename: Joseph
authors.initials: J
authors.lastname: Huh
authors.forename: Scott A
authors.initials: SA
authors.lastname: LeMaire
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Coselli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D001019:Aortic Rupture / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D002648:Child; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures; D055815:Young Adult