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Current role and outcomes of ascending aortic replacement for severe nonaneurysmal aortic atherosclerosis
Bartolo Zingone1, Giuseppe Gatti, Amedeo Spina
1Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy. bartolo.zingone@gmail.com
Insights
Ascending aorta replacement in severe atherosclerosis is feasible with acceptable mortality. This complex surgery, often combined with valve repair, shows promising long-term survival despite patient comorbidities.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Background:
- Severe ascending aorta atherosclerosis presents significant surgical challenges.
- Current treatment strategies lack standardization, leading to uncertainties in patient selection and procedural choices.
- This condition impacts operative decisions and patient outcomes.
Purpose of the Study:
- To evaluate the outcomes of ascending aorta replacement in patients with severe atherosclerosis.
- To assess the feasibility and safety of this procedure, particularly when combined with other cardiac surgeries.
- To analyze factors influencing patient survival and complications.
Main Methods:
- Ascending aorta replacement was performed in 64 patients undergoing aortic, mitral, or tricuspid valve surgery.
- Combined procedures, including coronary artery bypass grafting, were common.
- Deep hypothermic circulatory arrest was frequently employed, with advanced perfusion techniques.
Main Results:
- Early mortality, stroke, and myocardial infarction rates were 10.9%, 6.3%, and 7.8%, respectively.
- Preoperative renal failure and longer bypass/cardioplegia times were associated with early death.
- Cumulative survival rates at 1, 3, and 5 years were 86%, 74%, and 68%.
Conclusions:
- Ascending aorta replacement can be performed with acceptable mortality rates.
- The procedure is viable despite high preoperative comorbidity and postoperative complication rates.
- This approach offers a potential solution for managing severe ascending aorta atherosclerosis.
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.
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