The impact of thoracic aortic endograft explant on open descending and thoracoabdominal aortic replacement.

OBJECTIVE

Thoracic endovascular aortic repair (TEVAR) has become the primary treatment for descending thoracic aortic aneurysms and complicated acute type B aortic dissections. Consequently, a significant cohort of patients experience endograft failure or infection requiring open surgical explant. This study evaluated the impact of TEVAR explant on open descending (DTA) or thoracoabdominal aortic (TAA) replacement.

METHODS

Between January 2006 and January 2025, 442 adult patients underwent open DTA or TAAA repair at a single institution, among whom 68 patients (15%) had a previous TEVAR and underwent TEVAR explant (EXPLANT) at time of surgery.

RESULTS

Fifty-seven percent of patients underwent DTA and 43% underwent TAA replacement. Open DTA or TAA replacement occurred a median of 0.9 (0.3, 2.4) years after TEVAR. Indications for surgery included expanding aneurysm secondary to endoleak (75%) and graft infection (25%). Circulation management (left heart bypass or hypothermic circulatory arrest) was similar between EXPLANT and no EXPLANT groups. There was no difference in postoperative outcomes between EXPLANT and no EXPLANT groups including stroke (7.4% vs 5.6%) and paraplegia (10% vs 8.6%). Overall operative mortality was 19% and was similar between groups. TEVAR EXPLANT was not a risk factor for mortality (odds ratio, 1.14; P = .69). Among the EXPLANT group, explant for graft infection had a greater operative mortality (35%) compared with aneurysm (16%) (P = .10).

CONCLUSIONS

TEVAR explant for aneurysm expansion does not impact outcomes after open DTA or TAA aneurysm repair. However, explant of infected thoracic endografts typically requires circulatory arrest and is associated with increased mortality.