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OBJECTIVES Our goal was to evaluate outcomes in all-comer patients undergoing open thoracoabdominal aortic replacement either unsuitable for or after failed endovascular aortic repair. METHODS Within a 4-year period, we analysed a consecutive series of 80 patients undergoing elective, urgent and emergency thoracoabdominal aortic replacement. Preoperative data, intraoperative data and outcomes were evaluated. Specific attention was given to technical refinements needed in patients after previous endovascular aortic repair. RESULTS Eighty patients underwent thoracoabdominal aortic replacement: 11.3% (n = 9) had connective tissue disorders. Twenty-six patients (32.5%) had previous endovascular aortic repair and 54 (67.5%) did not have previous endovascular repair. The mean age was 64.2 ± 12 years, and 70% (n = 56) were male. The mean EuroSCORE was 7.9 ± 2.6. Urgent or emergency operations were done in 22.5% (n = 18). Overall mortality was 20% (n = 16); symptomatic spinal cord injury occurred in 5% (n = 4). We did not observe differences in survival according to the presence or absence of previous endovascular aortic repair (P = 0.524). Multivariate regression analysis revealed the amount of packed red blood cell units (P = 0.009, confidence interval 1.028–1.215, odds ratio = 1.117) as a predictor of in-hospital death. Follow-up was 100% (37.9 ± 15.8 months); freedom from aortic-related reintervention was 96.3%. CONCLUSIONS Despite an early attrition rate, survival after open thoracoabdominal aortic replacement is excellent, and freedom from aortic-related reintervention is high. Open surgery continues to remain an essential component in the treatment armamentarium of acute and chronic thoracoabdominal aortic pathology.

Results of open thoracoabdominal aortic replacement in patients unsuitable for or after endovascular repair with remaining disease components