Open Surgery of the Descending Thoracic Aorta in the Endovascular Era: A Single Centre Experience

Although thoracic endovascular aortic repair is the predominant treatment for most descending thoracic aorta (DTA) pathologies, a subset of patients remain unsuitable, leaving open surgical repair as their only viable option. This study reports the outcomes of open DTA repair performed in a high volume tertiary aortic referral centre.

Data on patients who underwent open repair for DTA pathology from 2013 to 2024 were collected retrospectively. Baseline characteristics, operative details, and post-operative outcomes were reviewed. The primary outcome was operative death; secondary outcomes included major adverse events (stroke, spinal cord ischaemia, tracheostomy, or dialysis).

Among 337 patients who underwent open thoraco-(abdominal) aortic repair, 95 (55 men; 58%), with a mean age ± standard deviation of 56.1 ± 14.0 years, underwent isolated DTA repair (71 elective; 75%). The most common indication was post-dissection aneurysm (n = 50; 53%), followed by (post-)coarctation pathology (n = 15; 16%). Six (6%) patients were operated on for stent graft infection. The most frequent reasons for thoracic endovascular aortic repair ineligibility were absence of a proximal landing zone (n = 26; 27%), complex post-dissection anatomy (n = 19; 20%), infection (n = 13; 14%), and connective tissue disease (n = 13; 14%). Thirty day and operative mortality rates were both 3% (n = 3). The ninety day mortality rate was 6% (n = 5). Major complications included stroke (n = 1; 1%) and spinal cord ischaemia (n = 2; 2%; one transient paraparesis and one permanent paraplegia). No cases required tracheostomy or permanent dialysis. In hospital re-intervention was observed in 15% and acute kidney injury in 12% (including one patient requiring temporary dialysis). Mean follow up ± standard deviation was 49.0 ± 38.5 months. One and five year overall survival were 94.7% and 91.6%, respectively, and freedom from aortic related re-intervention was 96.8% and 94.7%, respectively.

In selected patients, open DTA repair may be required when endovascular treatment is unfeasible or considered inappropriate. In experienced centres, it yields very low mortality and complication rates and should therefore still be considered as part of the treatment armamentarium.