Document Detail


Current role and outcomes of ascending aortic replacement for severe nonaneurysmal aortic atherosclerosis.
MedLine Citation:
PMID:  20103316     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Severe atherosclerosis of the ascending aorta is a challenging issue potentially affecting indications for surgery, operative choices, and patients' outcome. No standard treatment has emerged to date, and uncertainties persist about criteria for selecting patients and procedures. METHODS: Replacement of the atherosclerotic ascending aorta was performed in 64 patients at time of either aortic (n = 49), mitral (n = 21), or tricuspid (n = 7) valve surgery. Coronary artery bypass grafting was performed in 53 patients, and the majority of patients underwent combined procedures (n = 49). Mean age was 72.0 +/- 7.6 years. The expected operative mortality, by logistic European System for Cardiac Operative Risk Evaluation, was 29.0% accounting for ascending aortic replacement and 13.1% disregarding it. Circulatory arrest under deep hypothermia, eventually combined with either retrograde or antegrade brain perfusion, was required in 61 cases. RESULTS: Early death, stroke, and myocardial infarction rates were 10.9%, 6.3%, and 7.8%, respectively. Factors univariately associated with early deaths were preoperative renal failure requiring dialysis (p = 0.001) and longer cardiopulmonary bypass (p = 0.001) and cardioplegia (p = 0.008) times. Cumulative survival at 1, 3, and 5 years was 86% +/- 4%, 74% +/- 6%, and 68% +/- 8%, respectively. CONCLUSIONS: Replacement of the atherosclerotic ascending aorta can be carried out at acceptable mortality rates despite the high rates of preoperative comorbidity and the significant incidence of postoperative complications.
Authors:
Bartolo Zingone; Giuseppe Gatti; Amedeo Spina; Elisabetta Rauber; Lorella Dreas; Gabriella Forti; Aniello Pappalardo
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  89     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2010 Feb 
Date Detail:
Created Date:  2010-01-27     Completed Date:  2010-02-17     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  429-34     Citation Subset:  AIM; IM    
Copyright Information:
2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
Affiliation:
Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy. bartolo.zingone@gmail.com
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Aorta / surgery
Aortic Diseases / mortality,  surgery*
Atherosclerosis / mortality,  surgery*
Blood Vessel Prosthesis Implantation*
Cardiopulmonary Bypass
Cause of Death
Combined Modality Therapy
Coronary Artery Bypass
Female
Heart Valve Prosthesis Implantation
Hospital Mortality
Humans
Italy
Kidney Failure, Acute / mortality
Male
Middle Aged
Myocardial Infarction / mortality
Postoperative Complications / mortality
Risk Factors
Stroke / mortality
Survival Rate

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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