Emergent or urgent hybrid repair for complex thoracoabdominal aortic aneurysms: single-centre experience

Objective Emergent or urgent repair of thoracoabdominal aortic aneurysms (TAAA) always represent a major challenge due to high mortality and complex reconstruction of visceral arteries. We aimed to evaluate the short- and long-term outcomes of patients undergoing emergent or urgent hybrid TAAA repair under a standardized institutional perioperative protocol. Methods This study represents a retrospective cohort analysis of data derived from a prospectively maintained institutional database at West China Hospital. All consecutive patients who underwent emergent or urgent hybrid repair for TAAA between January 2013 and February 2025 were included. Results The cohort comprised 38 TAAA patients (31 male, with a median age of 50.5 years) who underwent emergent/urgent hybrid repair. The median aneurysm length was 200.9 mm (IQR 154.0-320.0), with a mean maximum diameter was 70.5 ± 17.8 mm. Intraoperatively, 4 visceral arteries (IQR 4-5) were reconstructed. Median operative time was 415 min (IQR 360-504), with median ICU and postoperative hospital stays of 96.0 h (IQR 46.5-203.5) and 17 days (IQR 11-24), respectively. No myocardial infarction or hepatic failure occurred. Postoperative complications included pulmonary infection ( n = 4, 10.5%), acute kidney injury ( n = 2, 5.3%), and spinal cord ischemia ( n = 5, 13.2%). Thirty-day mortality was 10.5% ( n = 4). The survival rates at 12 and 60 months postoperatively were 86.8% (95% CI 76.7–98.3) and 83.0% (95% CI 71.7–96.6). The free of reintervention rates at 12 and 60 months postoperatively were 90.5% (95% CI 80.8–100.0) and 76.4% (95% CI 61.1–95.7). Conclusion In this selected cohort managed with a standardized perioperative protocol, emergent and urgent hybrid TAAA repair was feasible, with acceptable perioperative mortality and durable mid- to long-term survival. However, the occurrence of spinal cord ischemia represents a substantial and clinically significant trade-off of this approach in the emergency setting. Moreover, these favorable survival outcomes should be interpreted in the context of the cohort's relatively young age and favorable baseline risk profile. These findings emphasize that survival benefit is counterbalanced by significant neurological morbidity, highlighting the need for refined spinal protection protocols in urgent cases and for comparative studies to validate the specific efficacy of this standardized protocol.