TY - JOUR
T1 - Reoperative aortic root and transverse arch procedures
T2 - A comparison with contemporaneous primary operations
AU - Etz, Christian D.
AU - Plestis, Konstadinos A.
AU - Homann, Tobias M.
AU - Bodian, Carol A.
AU - Di Luozzo, Gabriele
AU - Spielvogel, David
AU - Griepp, Randall B.
PY - 2008/10
Y1 - 2008/10
N2 - Objectives: Long-term survival and risk factors affecting outcome after reoperative root/ascending aorta and transverse arch procedures have not been clearly described. Methods: Two hundred patients (138 male patients; age, 60 ± 15 years) underwent reoperative root/ascending aorta (n = 100) or transverse arch (n = 100) procedures at our institution from January 1998 to December 2004 and were compared with 480 consecutive contemporaneous patients with primary procedures (323 male patients; age, 62 ± 16 years; 335 proximal aorta and 145 transverse arch procedures). Results: Reoperative proximal aorta procedures had a higher hospital mortality (7%) than primary root/ascending aorta procedures (3%), but there was a less dramatic difference in operative mortality after primary and reoperative arch procedures (9% vs 10%). Separate multivariable analyses of root/ascending aorta procedures and arch procedures revealed chronic obstructive pulmonary disease and age to be significant risk factors for death after either procedure. In addition, an ejection fraction of less than 30% posed a significant risk for proximal aortic surgery, and diabetes and nonelective operations predicted poorer outcome after arch operations. For survivors of root/ascending aorta operations, there was no significant difference in long-term outcome between reoperations and primary procedures, with both restoring longevity to expected levels for an age- and sex-matched normal population. Patients undergoing arch operations, however, continued to have a poorer long-term outlook than their normal peers. Conclusions: In this series, reoperations in the transverse arch carry the same risk as primary arch procedures, but a higher operative mortality is seen with reoperative than with primary root/ascending aorta procedures. The long-term outlook is better for patients undergoing root/ascending operations than for patients undergoing aortic arch operations, with no difference in the longevity of patients undergoing primary procedures versus reoperations.
AB - Objectives: Long-term survival and risk factors affecting outcome after reoperative root/ascending aorta and transverse arch procedures have not been clearly described. Methods: Two hundred patients (138 male patients; age, 60 ± 15 years) underwent reoperative root/ascending aorta (n = 100) or transverse arch (n = 100) procedures at our institution from January 1998 to December 2004 and were compared with 480 consecutive contemporaneous patients with primary procedures (323 male patients; age, 62 ± 16 years; 335 proximal aorta and 145 transverse arch procedures). Results: Reoperative proximal aorta procedures had a higher hospital mortality (7%) than primary root/ascending aorta procedures (3%), but there was a less dramatic difference in operative mortality after primary and reoperative arch procedures (9% vs 10%). Separate multivariable analyses of root/ascending aorta procedures and arch procedures revealed chronic obstructive pulmonary disease and age to be significant risk factors for death after either procedure. In addition, an ejection fraction of less than 30% posed a significant risk for proximal aortic surgery, and diabetes and nonelective operations predicted poorer outcome after arch operations. For survivors of root/ascending aorta operations, there was no significant difference in long-term outcome between reoperations and primary procedures, with both restoring longevity to expected levels for an age- and sex-matched normal population. Patients undergoing arch operations, however, continued to have a poorer long-term outlook than their normal peers. Conclusions: In this series, reoperations in the transverse arch carry the same risk as primary arch procedures, but a higher operative mortality is seen with reoperative than with primary root/ascending aorta procedures. The long-term outlook is better for patients undergoing root/ascending operations than for patients undergoing aortic arch operations, with no difference in the longevity of patients undergoing primary procedures versus reoperations.
UR - http://www.scopus.com/inward/record.url?scp=54049128967&partnerID=8YFLogxK
U2 - 10.1016/j.jtcvs.2007.11.071
DO - 10.1016/j.jtcvs.2007.11.071
M3 - Article
C2 - 18954623
AN - SCOPUS:54049128967
SN - 0022-5223
VL - 136
SP - 860-867.e3
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
IS - 4
ER -