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Risk of adding prophylactic aorta replacement to a cardiac operation
Jay J Idrees1, Eric E Roselli1, Eugene H Blackstone2
1Aorta Center, Heart and Vascular Institute, Cleveland, Ohio; Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland, Ohio.
The Journal of Thoracic and Cardiovascular Surgery
|July 2, 2019
Summary
Adding prophylactic aorta replacement to cardiac operations does not increase risks when aortic disease is mild. However, significant risks arise when advanced aortic disease is the primary surgical indication.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Aortic Surgery
Background:
- Cardiac operations are often performed with aortic replacement.
- The primary indication for surgery influences patient outcomes.
Purpose of the Study:
- To assess the risk of prophylactic aorta replacement during cardiac operations when aortic disease is not the primary indication.
- To compare outcomes between patients undergoing combined cardioaortic operations and cardiac-only surgery.
Main Methods:
- Propensity matching was used to compare patients undergoing cardioaortic operations (n=684) with those undergoing cardiac-only surgery (n=647).
- The study analyzed in-hospital stroke and mortality rates.
Main Results:
- No significant increase in stroke or mortality was observed when prophylactic aorta replacement was performed for mild ascending aorta dilatation (less than 5.5 cm).
- Patients with advanced aortic disease requiring surgery as the primary indication faced significantly higher risks of stroke and death.
Conclusions:
- Prophylactic aorta replacement can be safely integrated into cardiac operations for less severe aortic disease.
- Advanced aortic disease as the primary indication for surgery necessitates careful consideration of substantial associated risks.
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