Morbidity and Mortality

Despite tremendous development in surgical and anesthetic technique, mortality and complication rates remain high for open surgical repair of TAA. Contemporary mortality rates reported from large institutional series range from 5.2% to 14%. ^{[326] [327] [328] [329]} The nationwide mortality rate may be considerably higher (approximately 20%).^[330] The incidence of paraplegia or paraparesis in patients undergoing surgical repair of TAA is reported as 5% to 40%, depending on factors such as anatomic location, the duration of cross-clamp, the use of protective measures, the degree of dissection, and whether the aneurysm has ruptured.^{[314] [326] [327] [328] [329] [331] [332]} Extensive dissecting TAA repair carries the highest risk of neurologic deficit. In 210 consecutive open TAA repairs reported,^[333] three patients had paraplegia, and two patients had temporary paraparesis, for an overall neurologic deficit of 2.4% (1.4% permanent). Renal failure is reported to occur in 3% to 30% of patients, depending on similar factors described previously.^{[326] [334] [335] [336]} Overall, approximately 6% of patients need postoperative dialysis after TAA repair, which is associated with high mortality (30% to 60%).^{[326] [336]} Not surprisingly, pulmonary complications are the most common complication associated with TAA repair. The incidence of postoperative pulmonary insufficiency approaches 50%,^{[333] [337]} with 8% to 14% of patient requiring tracheostomy.^{[329] [337]} As with all other vascular surgical procedures, cardiac complications are common and are a leading cause of perioperative mortality.