title: Operative outcomes after open repair of descending thoracic aortic aneurysms in the era of endovascular surgery.
abstract: BACKGROUND
  Since the advent of endovascular techniques for repair of descending thoracic aortic aneurysms (DTAAs), there has been a relative paucity of current data for open repairs. The purpose of this study was to assess the operative and long-term outcomes in a contemporary series of open repairs of DTAAs.
  
  
  METHODS
  We conducted a retrospective review of 68 patients (63±14.5 years) who underwent DTAA repairs between January 1999 and December 2010. Forty-two patients (62%) were male, 16 (24%) had chronic obstructive pulmonary disease, 7 (10%) required dialysis preoperatively, 11 (16%) had contained rupture, 25 (37%) had previous cardioaortic operations, and 10 (15%) had previous aortic arch replacement (stage 1 elephant trunk). The entire descending thoracic aorta was replaced in 34 patients (50%). Cardiopulmonary bypass was used in 64 patients (94%) and deep hypothermic arrest in 22 (32%).
  
  
  RESULTS
  In-hospital mortality was 3% (2 patients). There was no immediate paraplegia. Delayed paraplegia developed in 1 patient (1.5%). Postoperative stroke occurred in 3 patients (4.4%), and 20 (29%) required prolonged ventilatory support (intubation≥48 hours). New-onset renal insufficiency (creatinine≥2.5 mg/dL) developed postoperatively in 6 patients (9%), and 1 (1.5%) required temporary dialysis. The median follow-up time was 5.8±3.8 years. Sixteen of the 66 operative survivors (24.2%) died during follow-up. Probability of survival was 82%±0.05% at 5 years and 67%±0.07% at 10 years. Reintervention was necessary in 4 patients (6%). Freedom from reintervention was 98%±0.02% at 5 years and 89%±0.06% at 10 years. The univariable predictor of long-term death was postoperative reintubation (p<0.05).
  
  
  CONCLUSIONS
  In the era of endovascular repair of DTAAs, operative death and morbidity outcomes for open repairs are observed to be low. In addition to good long-term survival rates, open repairs are durable, as evidenced by low reintervention rates.
authors.affiliation: The Aortic Wellness Center, Division of Cardiothoracic Surgery, Lenox Hill Hospital, North Shore LIJ Hospital System, New York, New York. Electronic address: mostafas@yahoo.com.
authors.forename: Mostafa
authors.initials: M
authors.lastname: Sadek
authors.affiliation: The Aortic Wellness Center, Division of Cardiothoracic Surgery, Lenox Hill Hospital, North Shore LIJ Hospital System, New York, New York.
authors.forename: Djamila
authors.initials: D
authors.lastname: Abjigitova
authors.affiliation: The Aortic Wellness Center, Division of Cardiothoracic Surgery, Lenox Hill Hospital, North Shore LIJ Hospital System, New York, New York.
authors.forename: Yonni
authors.initials: Y
authors.lastname: Pellet
authors.affiliation: The Aortic Wellness Center, Division of Cardiothoracic Surgery, Lenox Hill Hospital, North Shore LIJ Hospital System, New York, New York.
authors.forename: Aditya
authors.initials: A
authors.lastname: Rachakonda
authors.affiliation: The Aortic Wellness Center, Division of Cardiothoracic Surgery, Lenox Hill Hospital, North Shore LIJ Hospital System, New York, New York.
authors.forename: Georgia
authors.initials: G
authors.lastname: Panagopoulos
authors.affiliation: The Aortic Wellness Center, Division of Cardiothoracic Surgery, Lenox Hill Hospital, North Shore LIJ Hospital System, New York, New York.
authors.forename: Konstadinos
authors.initials: K
authors.lastname: Plestis
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D000792:Angiography / Q000379:methods; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D002315:Cardiopulmonary Bypass / Q000379:methods; D050792:Circulatory Arrest, Deep Hypothermia Induced / Q000379:methods; D015331:Cohort Studies; D057510:Endovascular Procedures / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D013908:Thoracotomy / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome