This study reports on open TAAA repair comparing short- and long-term patients' outcome according to the conducted type of repair defined by the Crawford classification and elective vs. emergency repair. Endpoints were mortality, acute kidney injury (AKI), sepsis, spinal cord ischemia (SCI) and re-intervention rate.

Retrospective study reporting outcome of 255 patients (between 2006 and 2019), designed according to the STROBE criteria. Frequencies and proportions of categorical variables were tabulated and continuous variables were analyzed using means, medians, standard deviations and minimum, maximum values. Associations of outcomes were analyzed using logistic regression models for each outcome parameter and odds ratio estimates are presented. Independent variables of models included age (years, continuous), sex (male/female), Crawford classification (5 categories), surgery type (elective/emergency), and preoperative renal insufficiency (yes/no). Patients with complete data were used in the analyses. Kaplan-Meier survival estimates were calculated using follow-up time from surgery. Hazard ratios were estimated using Cox models adjusted for age (years), sex (male/female), Crawford classification (5 categories), surgery type (elective/emergency) and preoperative kidney insufficiency (yes/no).

The TAAA-distribution was type I 25%, type II 26%, type III 23%, type IV 18%, and type V 7%. 51 (20%) patients had an emergency procedure. 51 % of all patients had a history of aortic surgery, 58% of all patients suffered from post-dissection TAAA, 26 % of all patients had a connective-tissue disease. In-hospital mortality rate among elective treated patients was 16 % (n = 33) vs. 35 % (n = 18) in the emergency subgroup; the total mortality rate was 20 % (n = 51). The adjusted Odds ratio for in-hospital mortality following emergency repair compared with elective repair was 2.52 (1.15; 5.48), the in-hospital mortality in the type II TAAA repair group was significantly higher than in the other subgroups (Figure 1 and 2). Temporary renal replacement therapy because of AKI was required in 29 % (n = 74) of all patients, sepsis from different cause was observed in 37 % (n = 94), SCI in 7% (n = 18, 10 patients suffering from paraplegia and 8 from paraparesis). The mean follow-up time was 3.0 years (median 1.5, 0-12.8 years). Aortic related re-intervention rate occurred in 2.8 %. Total mortality rate during follow up was 22.5 % (n =46), 5.3 % (n =11) of all patients died due to aortic-related events.

Open TAAA repair is associated with a relevant morbidity and mortality rate, yet the incidence of spinal cord ischemia may be favorably low, if a neuromonitoring protocol is applied. Aortic-related re-intervention and aortic-related mortality rate during follow-up are low.