SCTS annual meeting 2023 abstracts

Objectives: Open surgery remains the gold standard for the treatment of the thoracoabdominal aorta (TAA).The rising number of endovascularly treated patients comes with an increase in the number of patients who require secondary open interventions due to the complex nature of the aortic disease or to treat endovascular complications.Methods: We describe our current approach to secondary open extent II TAA repair in patients with prior endovascular repair.We also describe our experience with this cohort of patients in our institution between 2017 and 2022 (n = 22).Results: We routinely use left heart bypass with mild passive hypothermia (34 °C), cerebrospinal fluid drainage, sequential aortic crossclamping, motor evoked potentials monitoring, oxygen saturations and selective visceral perfusion with blood and renal protection with Custodiol.We advocate for reimplantation of intercostal arteries.Between September 2017 and August 2022 a total of 22 patients underwent secondary open TAA repair after previous endovascular therapy in our institution.Mean age was 56.5 years (20-78), and 77% were male.Previous endovascular treatment consisted of TEVAR (16, 73%), EVAR/ FEVAR (5, 23%) and FET (1, 4%).Indications included aneurysmal expansion (12, 54%), endoleak (4, 18%), stent misplacement (3, 14%) and infection (3, 14%).Extent of the open TAA repair included: DTA (6, 27%), Crawford I (1, 4%), II (11, 50%), III (3, 14%) and IV (1, 4%).14 patients (64%) were elective, while 8 cases (36%) were urgent/emergencies.Median time to open TAA surgery from endovascular treatment was 31 months (0.5-264 months).In-hospital mortality was 32% (7 patients).Postoperative complications include haemofiltration (11, 50%), tracheostomy (3, 14%) and paraplegia (3, 14%).Conclusions: Favourable early outcomes and a durable repair can be achieved at experienced high-volume centers, with pre-operative selection and multidisciplinary team based intraoperative and postoperative management of these patients.