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

• Published in: Journal of vascular surgery 2021-05, Vol.73 (5), p.1525-1532.e4
• Main Authors: Harky, Amer, Othman, Ahmed, Shaw, Matthew, Nawaytou, Omar, Harrington, Deborah, Kuduvalli, Manoj, Kendall, Johnathan, Torella, Francesco, Field, Mark
• Format: Article
• Language: English
• Subjects: Aneurysm; Aorta; Morbidity; Mortality; Multidisciplinary team
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2020.09.027

To report our outcomes and identify predictors of mortality after open descending thoracic aneurysm (DTA) and thoracoabdominal aortic aneurysm (TAAA) repair in a specialist aortic center. This retrospective observational cohort study included consecutive patients who underwent surgery at our institution between October 1998 and December 2019. The main outcome measures were mortality and major morbidities. A multivariate analysis was used to identify predictors of mortality. There were 430 patients who underwent DTA (n = 157) and TAA (n = 273) repair; 151 underwent surgery nonelectively. Forty-eight patients (11%) died within 30 days of surgery. The 30-day mortality was lower after elective surgery (3.1% after DTA repair and 9.9% after TAAA repair), whereas nonelective surgery had a 30-day mortality of 17.9%. Fourteen additional patients died in hospital after 30 days, one after nonelective 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 years (odds ratio [OR], 3.36; 95% confidence interval [CI], 1.79-6.32; P < .001), extent II repair (OR, 4.39; 95% CI, 2.34-8.21; P < .001), nonelective surgery (OR, 2.72; 95% CI, 1.44, 5.12; P = .002), out-of-hours surgery (OR, 8.17; 95% CI, 2.16-30.95; P = .002), a left ventricular ejection fraction of