title: Results of open thoracoabdominal aortic aneurysm repair.
abstract: BACKGROUND
  Open surgical repair of thoracoabdominal aortic aneurysms (TAAAs) enables the effective replacement of the diseased aortic segment and reliably prevents aneurysm rupture. However, these operations also carry substantial risk of perioperative morbidity and mortality, principally caused by the associated ischemic insult involving the spinal cord, kidneys, and other abdominal viscera. Here, we describe the early outcomes of a contemporary series of open TAAA repairs.
  
  
  METHODS
  We reviewed the outcomes of 823 open TAAA repairs performed between January 2005 and May 2012. Of these, 209 (25.4%) were Crawford extent I repairs, 264 (32.1%) were extent II, 157 (19.1%) were extent III, and 193 (23.5%) were extent IV. Aortic dissection was present in 350 (42.5%) cases, and aneurysm rupture was present in 37 (4.5%). Adjuncts used during the procedures included cerebrospinal fluid drainage in 639 (77.6%) cases, left heart bypass in 430 (52.2%), and cold renal perfusion in 674 (81.9%).
  
  
  RESULTS
  The composite endpoint, adverse outcome-defined as operative death, renal failure that necessitated dialysis at discharge, stroke, or permanent paraplegia or paraparesis-occurred after 131 (15.9%) procedures. There were 69 (8.4%) operative deaths. Permanent paraplegia or paraparesis occurred after 42 (5.1%) cases, stroke occurred after 27 (3.3%), and renal failure necessitating permanent dialysis occurred after 45 (5.5%).
  
  
  CONCLUSIONS
  Although open surgical repair of the thoracoabdominal aorta can be life-saving to patients at risk for fatal aneurysm rupture, these operations remain challenging and are associated with substantial risk of early death and major complications. Additional improvements are needed to further reduce the risks associated with TAAA repair, particularly as increasing numbers of patients with advanced age and multiple or severe comorbidities present for treatment.
authors: Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine; and Department of Cardiovascular Surgery, The Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas, USA.
authors: Scott A
authors: SA
authors: LeMaire
authors: Matt D
authors: MD
authors: Price
authors: Susan Y
authors: SY
authors: Green
authors: Samantha
authors: S
authors: Zarda
authors: Joseph S
authors: JS
authors: Coselli
keywords: Aorta, abdominal; aorta, thoracic; aortic aneurysm, thoracic/surgery; cardiovascular surgical procedures
references: Ann Thorac Surg. 2007 Apr;83(4):1345-55; discussion 1355
references: 17383338
references: J Vasc Surg. 2011 May;53(5):1195-1201.e1
references: 21315544
references: Anesthesiology. 2011 Nov;115(5):1093-102
references: 21878808
references: J Thorac Cardiovasc Surg. 2011 Apr;141(4):953-60
references: 20621310
references: J Am Coll Surg. 2011 Apr;212(4):569-79; discussion 579-81
references: 21463791
references: J Vasc Surg. 2011 Jun;53(6):1492-8
references: 21514769
references: Eur J Vasc Endovasc Surg. 2009 Jun;37(6):640-5
references: 19362499
references: J Extra Corpor Technol. 2012 Mar;44(1):P31-7
references: 22730870
references: J Vasc Surg. 2002 Apr;35(4):631-9
references: 11932655
references: J Vasc Surg. 2006 Feb;43(2):217-22; discussion 223
references: 16476589
references: Ann Thorac Surg. 2013 Jan;95(1):12-9; discussion 19
references: 22785215
references: Ann Thorac Surg. 2001 Apr;71(4):1233-8
references: 11308166
references: J Vasc Surg. 2009 Jan;49(1):36-41
references: 18829232
references: Ann Thorac Surg. 2002 Mar;73(3):730-8
references: 11899174
references: J Vasc Surg. 2009 Jan;49(1):11-9; discussion 19
references: 19028052
references: J Vasc Surg. 1986 Apr;3(4):578-82
references: 3959256
references: J Vasc Surg. 2003 Jun;37(6):1169-74
references: 12764260
references: Ann Thorac Surg. 2010 Oct;90(4):1237-44; discussion 1245
references: 20868820
references: J Thorac Cardiovasc Surg. 2010 Dec;140(6):1319-24
references: 20346468
references: J Vasc Surg. 1986 Mar;3(3):389-404
references: 3951025
references: Semin Vasc Surg. 2008 Mar;21(1):13-20
references: 18342730
references: Ann Cardiothorac Surg. 2012 Sep;1(3):394-7
references: 23977525
references: Ann Thorac Surg. 1999 Jun;67(6):1931-4; discussion 1953-8
references: 10391341
references: J Thorac Cardiovasc Surg. 2012 Apr;143(4):945-952.e1
references: 22341417
references: J Vasc Surg. 2001 Jul;34(1):54-61
references: 11436075
references: Ann Cardiothorac Surg. 2012 Sep;1(3):381-93
references: 23977524