Open repair of descending and thoracoabdominal aortic aneurysms in octogenarians

Abstract Objective Despite improved outcomes for open repair of descending thoracic aneurysm (DTA) and thoracoabdominal aortic aneurysm (TAAA), these operations remain challenging in octogenarians. Patients unsuitable for thoracic endovascular aortic repair require open surgery to avoid catastrophic rupture. We analyzed our results for DTA/TAAA repair in these elderly patients. Methods Our institutional aortic database was queried to identify those ≥80 years old and those  Results From 1997 to 2017, there were 783 patients who underwent open repair of DTA or TAAA; 96 (12.3%) were ≥80 years old. Octogenarians were more likely to be female ( P  = .018), with chronic pulmonary disease ( P  = .012), severe peripheral vascular disease ( P P  = .025). Degenerative aneurysms were more common among octogenarians ( P P P  = .852). Other than an increased incidence of left recurrent nerve palsy in the younger cohort ( P  = .029), there were no significant differences in the incidence of major postoperative complications. Logistic regression modeling showed that age ≥80 years was not predictive of operative mortality or postoperative complications. A greater percentage of octogenarians had aortic reconstruction with a clamp and sew strategy (85.4% vs 61.6%; P P P Conclusions In select octogenarians, open repair of DTA/TAAA can be performed with acceptable risk. A simplified surgical approach may provide the best opportunity for a successful outcome.