Contemporary outcomes of open aortic reconstruction from a high-volume aortic center

Objectives To evaluate the contemporary results of open aortic reconstruction (OAR) at a single-center, high-volume institution. Methods A retrospective review identified 318 patients who underwent elective OAR from January 2014 to December 2023. Ruptured aneurysms, thoracoabdominal aortic aneurysms, perivisceral/aortoiliac endarterectomies, and infectious etiologies were excluded. Demographics, comorbidities, and operative details were collected, including clamp location and the need for adjunct procedures. The primary endpoint was in-hospital mortality and secondary endpoints included major adverse events. Chi-square, Fisher's exact, Kaplan-Meier, and Cox proportional hazard model were used as appropriate. Results A total of 318 patients were included for analysis. Mean age was 65.1 ± 9.9 years, and 210 (66.0%) were male. Indications for operations were aneurysmal disease (AD) in 187 patients (58.8%) and occlusive disease (OD) in 131 (41.2%). A majority of patients (57.2%) required inter-renal or more proximal aortic control. Overall, 117 (36.8%) patients underwent reconstructions requiring more than 3 anastomoses. Overall, 117 (36.8%) patients underwent reconstructions requiring > 3 anastomoses. Composite in-hospital mortality was 4.1% and did not differ between AD (5.3%) and OD (2.3%) (P=0.12). Multivariable analysis showed advanced age, aortorenal endarterectomy, higher number of anastomoses, increased operative time with higher estimated blood loss (EBL) and temporary abdominal closure (TAC), and low-volume surgeon were associated with higher perioperative mortality. Conclusions OAR requires high technical expertise in the current era, often requiring proximal aortic control and extensive concomitant vascular reconstruction. However, it can be performed safely with acceptable mortality for both AD and OD in a high-volume referral center. Advanced age, higher EBL, TAC and low-volume surgeon were associated with higher perioperative mortality.