Aim To investigate the clinical effect and postoperative complications of total thoracoabdominal aortic aneurysm repair (tTAAAR) in patients with thoracoabdominal aortic aneurysm (TAAA). Methods A retrospective analysis was made for 14 patients with TAAA who were treated by open surgery from April 2010 to April 2019 in our hospital, including 11 cases of Crawford Ⅱ and 3 cases of Crawford Ⅲ. There were 12 males and 2 females, 28-54 years old, with an average age for (36.1±7.1) years. 4 patients underwent traditional deep hypothermic cardiopulmonary bypass tTAAAR and 10 patients underwent modified normothermia non-cardiopulmonary bypass tTAAAR. The traditional way was to establish the arteriovenous pathway for extracorporeal bypass under deep hypothermia cardiopulmonary bypass, and the improved way was to establish the descending aorta iliac artery bypass under normothermia non-cardiopulmonary bypass. Results The operation of all the 14 patients were completed. The blocking time of descending aorta was (22.2±9.6) minutes, and the ischemic time of spinal cord was (23.0±7.3) minutes. Early postoperative death occurred in 2 cases, acute renal insufficiency in 4 cases, paraplegia in 3 cases, pulmonary infection in 4 cases, transient brain dysfunction in 4 cases. One patient underwent splenectomy during operation and one patient underwent tracheotomy after operation. Conclusion Open tTAAAR is a relatively safe and effective surgical method, which is currently an effective treatment for some complex TAAA.