Objectives: The aim of our study was to report our experience of the surgical repair for thoracoabdominal aortic aneurysms (TAAAs) over the last 27 years.
Methods: We reviewed the prospectively collected data of 571 patients who underwent open TAAA repair between 1981 and 2008. Data were analyzed using univariate and multivariate analysis (logistic regression). Pre-, intra- and postoperative risk factors were used to develop risk models for in-hospital mortality, spinal cord deficit and renal failure.
Results: Seventy patients (12.3 %) died in the hospital, 30-day mortality was 8.9 %, 37 patients (6.5 %) required postoperative dialysis, 47 patients (8.3 %) developed paraplegia or paraparesis. The incidence of paraplegia in the left heart bypass group was 4.4 %. Predictors for hospital mortality were increasing age (Odds Ratio 1.096 per year, 95 % CI 1.05 – 1.14) and the need for hemodialysis (Odds Ratio 10, 95 % CI 4.7 – 21.1). For postoperative spinal cord deficit we found three protecting factors: age above 75 years (Odds Ratio 0.14, 95 % CI 0.19 – 1.09), presence of a postdissection aneurysm (Odds Ratio 0.4, 95 % CI 0.17 – 0.94) and combined use of cerebrospinal fluid drainage and motor evoked potentials (Odds Ratio 0.28, 95 % CI 0.14 – 0.56). Urgency (Odds Ratio 4, 95 % CI 1.8 - 9) and preoperative serum creatinine level (Odds Ratio 1.007 per micromol/L, 95 % CI 1.0 – 1.01) were significant risk factors for renal failure.
Conclusions: Open TAAA repair intrinsically has substantial complications of which spinal cord ischemia and renal failure are the most devastating, despite major progress in our understanding of the pathophysiology and operative strategy.