Contemporary results of open thoracic and thoracoabdominal aortic surgery in a single United Kingdom centre.

OBJECTIVE To report outcome and identify predictors of mortality after open descending thoracic aneurysm (DTA) and thoracoabdominal aortic aneurysm (TAAA) repair in a specialist aortic centre. METHODS This was a retrospective observational cohort study. Consecutive patients who underwent surgery at our institution between October 1998 and December 2019 were included. The main outcome measures were mortality and major morbidity. Multivariate analysis was used to identify predictors of mortality. RESULTS 430 patients underwent DTA (n=157) and TAA (n=273) repair; 151 underwent surgery non-electively. Forty-eight (11.6%) died within 30 days of surgery. Thirty-day mortality was lower after elective surgery (3.1% after DTA repair and 9.9% after TAAA repair), whereas non-elective surgery carried a 30-day mortality of 17.9%. Fourteen additional patients died in hospital after 30 days, one after non-elective DTA repair and 13 after TAAA repair (10 elective), all but one extent II. In-hospital mortality for the whole cohort improved over time, as the activity volume increased, except for patients undergoing extent II TAAA repair. Predictors of in-hospital mortality were: age ≥70 (OR 3.36; 95%CI=1.79-6.32, P<0.001); extent II repair (OR 4.39; 95%CI=2.34-8.21), P<0.001); non-elective surgery (OR 2.72; 95%CI=1.44, 5.12), P=0.002); out-of-hours surgery (OR 8.17; 95%CI=2.16-30.95), P=0.002), left ventricular ejection fraction <30% (OR 9.86; 95%CI=1.91-50.86, P<0.006) and surgery for degenerative aneurysm (OR=2.20; 95%CI=1.12-4.31, P=0.02).The incidence of stroke and paraplegia was 7.1% and zero after DTA repair; 9.9% and 3.3% after TAAA repair. Haemodialysis was necessary in 5.1% of cases after DTA repair and 22.7% after TAAA repair. CONCLUSION Open thoracoabdominal aortic surgery carries significant risk to life, which is related to age, extent of aortic replacement, timing of surgery and left ventricular function. Morbidity is considerable. Understanding these risks is fundamental for patient selection and the consent process of potential candidates for surgery particularly in the elderly.