Journal
ANNALS OF THORACIC SURGERY
Volume 84, Issue 4, Pages 1180-1185Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.athoracsur.2007.05.038
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Background. Advances in graft materials, hemostasis, and surgical techniques have facilitated surgery on the thoracic aorta. We investigate the current safety level of these operations - for the purposes of enabling risk/ benefit decisions for surgery and also to serve as a benchmark for comparison with emerging endovascular approaches. Methods. Five hundred six consecutive patients ( 315 male, 191 female; aged 14 to 91 years [ mean, 61]) underwent surgery on the thoracic aorta at one institution from 1995 to 2004. In all, 360 operations involved the ascending and arch (71.1%) and 130 (25.7%) involved the descending or thoracoabdominal aorta, or both, and 16 (3.2%) were classified as miscellaneous aortic operations. Clinical data collected prospectively were analyzed retrospectively using chi(2) and multivariable logistic regression statistics for the outcomes reoperation for bleeding, perioperative ( hospital or 30-day) mortality and stroke. Midterm survival was assessed by Kaplan-Meier methodology. Results. Mortality for elective operations on the ascending/ arch was 3.0%; mortality for elective operations on the descending aorta was 2.9%. Mortality for elective thoracoabdominal operations was 11.9%. Mortality for all operations was 8.6%. Probability of stroke was 3.0% for ascending/ arch, 4.2% for descending, and 2.1% for thoracoabdominal operations. The paraplegia rate was 7.3% for all descending and thoracoabdominal operations. Age and emergency operation predicted increased risk of death, stroke, and reoperation for bleeding. For young patients ( less than 55 years old) having elective ascending/ arch operations, freedom from permanent complications of operation ( death, stroke, paraplegia) was 98%. Overall survival at 1, 3, and 5 years was 84.7%, 78.3%, and 72.5%, respectively. Conclusions. Aortic surgery is quite safe in the current era and leads to good long-term survival for this patient group. These data support prophylactic replacement of the thoracic aorta in patients with poor expected natural history ( based on aneurysm size or symptoms). As catheter-based therapies proliferate, surgical data provide a benchmark that must be equaled or exceeded by newer endovascular approaches.
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