Proximal aortic repair in asymptomatic patients

Area of Science:

• Cardiovascular Surgery
• Aortic Surgery
• Surgical Outcomes Research

Background:

• Current guidelines for elective proximal aortic repair target specific patient groups with defined aortic diameters or growth rates.
• These guidelines are primarily for asymptomatic patients without connective tissue disorders or other primary indications.
• Characterizing surgical outcomes in this narrowly defined population is crucial for refining treatment strategies.

Purpose of the Study:

• To evaluate the surgical outcomes of elective proximal aortic repair in patients strictly adhering to current guidelines.
• To assess early (30-day/in-hospital) and 1-year mortality rates.
• To determine the incidence of major postoperative complications within 1 year.

Main Methods:

• A cohort of 935 patients undergoing proximal aortic repair (2014-2019) was screened.
• Patients excluded included those undergoing total arch replacements, reoperations, or presenting with acute symptoms or genetic syndromes.
• The final study population (n=262) included guideline-compliant patients, with outcomes tracked for mortality and major complications.

Main Results:

• The study population (n=262) had a median age of 63 years and a median surgical risk score of 3.2%.
• Early mortality was low at 0.76% (2/262), with no additional deaths by 1 year.
• Major complications were infrequent, including stroke (0.76%), renal insufficiency (0.76%), and re-exploration (7.6%), all occurring within 30 days.

Conclusions:

• Elective proximal aortic repair in guideline-adherent patients demonstrates exceptionally low mortality and complication rates.
• Current surgical outcomes support the safety and efficacy of these procedures in the defined population.
• Guidelines should consider these favorable surgical risks when comparing them to conservative management options.