Open XXXX repair in the modern era: results from a 20-year single-centre experience.

@entity1 @entity5880 @entity558 @entity1333 @entity2334 @entity439 @entity451
OBJECTIVES: The efficacy and durability of actual treatments (open, endovascular and hybrid) for @entity2334 ( @entity2334 ) repair are not yet completely defined. Open surgical repair using a multi-adjunct (ADJ) approach has been the standard of care for many years and may still be an effective treatment option. This study aimed to assess the outcomes of open @entity2334 repair since the introduction of the available ADJ. METHODS: From 1994 to 2014, 542 consecutive @entity1 underwent open @entity2334 repair in our institution, routinely receiving aortic distal perfusion and the other ADJ (either for visceral and spinal cord protection). The aetiology of @entity2334 was identified to be degenerative in 325 (60%) @entity1 and chronic post-dissection in 160 (29.5%) @entity1 . Other causes such as connective tissue disorders, @entity1333 and @entity5880 were less represented (10.5%). Extensive type I and II repair was required in 128 (23.6%) and 285 (52.6%) @entity1 , respectively. All @entity1 were followed up at 3 and 6 months after surgery and yearly thereafter using computed tomography angiogram. RESULTS: The overall 30-day mortality and @entity451 rates were 8.5 and 4.2%, respectively. Age [odds ratio (OR) 1.07 per year, 95% confidence interval (CI) 1.02-1.13], female gender (OR 2.52, 95% CI 1.27-4.99), urgency (OR 2.78, 95% CI 1.12-6.20) and emergency (OR 3.81, 95% CI 1.00-11.50) emerged as independent risk factors for 30-day mortality. Follow-up was 100% complete (mean 6.32 years). Overall 1-, 5- and 10-year survival was 85.9    1.5, 74.2    2.0 and 61.6    2.5%, respectively. The extent of surgical repair did not significantly influence late hospital death (P = 0.56). For @entity1 surviving the first 30 days, a degenerative @entity439 aetiology negatively impaired long-term survival compared with the other diseases [hazard ratio = 1.66; 95% CI (1.13-2.44)]. Five- and 10-year freedom from reoperation was 86.3    1.8 and 80.7    2.3%, respectively, and 8.5% of @entity1 required aortic reinterventions. CONCLUSIONS: In elective cases, open @entity2334 repair has to be considered an effective option associated with low necessity of reoperation at follow-up. The extent of aortic resection did not affect long-term mortality. Conversely, survival was mainly determined by @entity1 age and @entity558 .
