Objective

Thoracic endovascular repair (TEVAR) has become the preferred treatment of descending thoracic aorta (DTA) disease if the anatomy is suitable. However, clinical outcome of open repair (OR) of DTA has proven to be safe and effective in young patients and long-term outcome after OR appears to be more favourable than after TEVAR. We aim to review our experience with OR of DTA in patients aged younger than 70 years to establish if the operative risk is high enough to justify an endovascular approach.

Methods

We interrogated our prospectively maintained database to identify all patients younger than 70 years old, who underwent OR of the DTA. There were 67 patients (42 male, 62.7%). Median [IQR] age was 53 [40-63] years and 48 patients were aged 60 years or less. There were 31 urgent/emergency cases (46.3%). Twenty-one patients required hypothermic circulatory arrest to perform either a distal arch replacement (17, 25.4%) or a hemiarch replacement (4, 6.0%).

Results

There was one in-hospital mortality (1.5%) and one case of stroke (1.5%), with no cases of spinal cord injury (SCI) in the entire cohort. There were no cases of in-hospital death, stroke or SCI in patients younger than 60 years old and in patients with non-emergency presentation.

Conclusion

Young patients are usually excellent candidate for OR which can be performed with excellent results, improving long-term outcome. In cases of emergency (i.e. dissection and trauma), TEVAR can performed with excellent results and faster than OR and should remain the treatment of choice. Patients without significant comorbidities presenting with non-emergency conditions, especially if of young age, should be offered surgical repair in view of low operative risk and excellent long-term results.