Characterizing One-Year Mortality in Early Survivors of Open Thoracoabdominal Aortic Repair

Although operative mortality after open thoracoabdominal aortic aneurysm (TAAA) repair is well characterized, only limited data describe 1-year survival among patients who survive the index hospitalization. This study sought to further characterize 1-year mortality among operative survivors of open TAAA repair.

From January 1986 through July 2025, 3838 open TAAA repairs were performed within our single practice. After operative deaths and patients lacking 1-year follow-up were excluded, 3378 early survivors comprised the study cohort. Demographic, operative, and postoperative data were compared between patients who survived ≥1 year after repair and those who did not. Multivariable logistic regression was used to identify independent predictors of 1-year mortality.

Among early survivors, 328 (9.7%) died within 1 year. One-year mortality was associated with older age, prior percutaneous coronary intervention, prior stroke, and chronic kidney disease. Postoperative complications-namely paraplegia (odds ratio [OR] 1.96, P=.03), dialysis dependence (OR 2.00, P=.001), arrhythmia (OR 1.48, P=.01), tracheostomy (OR 2.17, P<.001), and 1-year repair failure (OR 5.13, P<.001)-independently predicted death, whereas elective repair (OR 0.57, P<.001) and discharge home (OR 0.38, P<.001) predicted 1-year survival. Model discrimination was good (C-statistic=0.77 [0.74-0.81]). Kaplan-Meier analysis showed markedly greater 1-year survival in patients initially discharged home (94%) versus elsewhere (73%; P<.001).

Among operative survivors of open TAAA repair, 1-year mortality remains considerable and is primarily determined by persistent postoperative complications and repair durability rather than intraoperative variables. Vigilant surveillance, structured rehabilitation, and multidisciplinary follow-up may be needed to ensure success beyond the perioperative period.