Surgical solutions for thoracoabdominal aortic aneurysms

Aim. The aim of this study was to report our experience of TAAA open repair over the last 5 years with a routinary multimodal approach used to maximize organ protection. Methods. Since 1991, a total of 388 open surgical repair of the thoracoabdominal aorta were performed in our Center. The details of 254 consecutive patients (176 males; mean age 66.4 years, range 15-82) operated between 2006 and 2011 were analyzed. Within this cohort, there were 52 Crawford extent type I aneurysms, 59 type II, 80 type III and 63 type IV. Cerebrospinal fluid drainage (CSFD), left heart bypass (LHBP), selective visceral perfusion and critical intercostal arteries reattachment have been used in case of extensive aneurysm repair. Results. CSFD and LHBP were employed in 97.3% and 94.6% of patients with type I or II aneurysms and in 71.3% and 53.6% of patients with type III or IV aneurysms, respectively. One hundred fifty-two patients (59.8%) had intercostal artery reattachment. Thirty-day mortality rate was 10.2%. Renal failure necessitating hemodialysis at discharge developed in 13 patients (5.1%); three patients (1.2%) presented mesenteric ischemia. Cardiac complications occurred in 22 patients (8.7%). Overall neurological complications rate was 8.2%, including 9 (3.5%) cases of transient paraparesis/paraplegia and 12 (4.7%) cases of permanent paraplegia. Conclusion. Despite evolving adjunctive strategies, morbidity and mortality rates following TAAA surgical repair are not negligible. Surgical TAAA repair is to be performed in high-volume Centers by experienced surgeons. Conventional treatment is the gold standard for patients fit for open surgery; results of hybrid and endovascular treatment of TAAA are to be compared to it.