Impact of pre-existing conditions, age and the length of cardiopulmonary bypass on postoperative outcome after repair of the ascending aorta and aortic arch for aortic aneurysms and dissections.

Abstract

BACKGROUND:

Repair of the ascending aorta and aortic arch carries a high morbidity and mortality, which can be complicated by the often emergent nature of the intervention.

METHODS:

We retrospectively evaluated the morbidity, mortality, and long-term survival in 101 patients who underwent repair of ascending aorta and aortic arch. Depending on the urgency of the operation, the patients were categorized as elective (EL, n=82) or emergent (EM, n=19). Log-rank-list and SPS were used to evaluate the data.

RESULTS:

The average age was 58+/-16 years. The aortic diameter was 5.5+/-1 cm in the EL group and 6.1+/-1.4 cm for EM group. The aortic dissection in EL and EM groups was 15% and 79%, respectively. The mean circulatory arrest time (n=32 patients) was 38+/-18.5 min. The overall 30-day mortality was 4%: 0% for the EL group and 26% for the EM group. The overall 6-month mortality was 8%: 3.7% and 26% in EL and EM groups, respectively. Overall CVA was 3%: 0% in the EL group and 15.7% in the EM group. The mean CPB time was 176+/-81 min. The prolonged CPB time correlated with increased need for blood transfusion. The LOS was 12+/-8 days and correlated with increasing age (95% CI 0.06860-0.2307, P=0.0004), with NYHA stage of patients at the time of surgery (95% confidence intervals, 1.328-4.202, P=0.0003), with left ventricular ejection fraction (95% CI 0.2357 to -0.003029, P=0.0442) and with postoperative atrial fibrillation (95% CI 0.1192-0.4745, P=0.0018). The average ICU stay was 123+/-145 h. A prolonged CPB time resulted in extended ICU stay (95% CI 0.3655-1.486, P=0.0014). Further, the length of ICU stay correlated with NYHA status (95% CI 19.98-73.42, P=0.0008), age (95% confidence intervals 0.01668-3.761, P=0.0477), urgency of surgery (95% CI 65.00-124.0, P<0.0001), and length of CPB time (95% CI 0.3655-1.486, P=0.0014).

CONCLUSION:

Emergent operations are associated with high morbidity and mortality. Pre-existing heart failure, advanced age, and prolonged cardiopulmonary bypass are associated with prolonged monitoring in the ICU.

• Authors: Jeffrey P Schwartz, Mamdouh Bakhos, Amit Patel, Sally Botkin, Siyamek Neragi-Miandoab
• Journal: Interactive cardiovascular and thoracic surgery (Interact Cardiovasc Thorac Surg) Vol. 7 Issue 5 Pg. 850-4 (Oct 2008) ISSN: 1569-9285 [Electronic] England
• PMID: 18617554 (Publication Type: Journal Article)

Topics

• Adult
• Age Factors
• Aged
• Aortic Dissection (complications, mortality, pathology, surgery)
• Aortic Aneurysm, Thoracic (complications, mortality, pathology, surgery)
• Cardiopulmonary Bypass (adverse effects, mortality)
• Emergency Treatment
• Female
• Heart Failure (complications)
• Humans
• Intensive Care Units
• Length of Stay
• Male
• Middle Aged
• Retrospective Studies
• Risk Assessment
• Risk Factors
• Time Factors
• Treatment Outcome
• Vascular Surgical Procedures (adverse effects, mortality)