Outcomes Following Contemporary Open Thoracoabdominal Aortic Aneurysm Extent I Repair: A Cross-Border Study

OBJECTIVES: Extent I open thoraco-abdominal aortic aneurysm repair remains essential for patients without endovascular options. This study evaluates outcomes and identifies factors associated with major adverse events. METHODS: This retrospective multicentre study included all patients who underwent open extent I thoraco-abdominal aortic aneurysm repair. Major adverse events were defined as operative death, stroke, paraplegia, paraparesis, or renal failure requiring renal replacement therapy. Univariable logistic regression analysis with odds ratios (OR) and 95% confidence intervals (CI) was used to identify risk factors for operative mortality and major adverse events. RESULTS: A total of 171 patients underwent extent I thoracoabdominal aortic aneurysm repair and were included. Emergency or urgent repair was performed in 14.6% of cases. Genetically triggered aortopathies were present in 16.5% of patients. In-hospital mortality occurred in 14.6%, with major adverse events in 23.3%. Stroke occurred in 4.6%, paraplegia in 2.9%, paraparesis in 5.2%, and permanent dialysis in 4.0%. Risk factors for operative mortality identified by univariable analysis included increasing age (OR, 1.074; 95% CI, 1.026-1.124) and previous myocardial infarction (MI) (OR, 5.920; 95% CI, 1.964-17.841). Factors associated with major adverse events included increasing age (OR, 1.053; 95% CI, 1.020-1.088), coronary artery disease (OR, 3.065; 95% CI, 1.274-7.376), previous MI (OR, 5.931; 95% CI, 2.012-17.488), and history of coronary artery bypass grafting (OR, 5.192; 95% CI, 1.161-23.223). Postoperative complications significantly associated with adverse outcomes included tracheostomy, ARDS, sepsis, and cardiac complications. The reintervention rate post-discharge was 15.8%. An overall 58.6% 5-year survival and 65.7% survival at 5 years following elective surgical repair were found. CONCLUSIONS: Extent I open thoraco-abdominal aortic aneurysm repair, while carrying significant risks of morbidity and mortality, is an established treatment for a subset of patients with no endovascular alternatives, with adequate long-term survival and low aortic reintervention rate during follow-up.