Open surgical replacement of the descending aorta: single-center experience
Saad Rustum1, Sebastian Lübeck1, Erik Beckmann1
1Department of Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
Insights
Elective open surgical descending aortic replacement shows excellent perioperative outcomes. Long-term results confirm prosthetic graft safety and efficacy in managing aortic aneurysms and dissections.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Background:
- Single-center study analyzing clinical outcomes of elective open surgical descending aortic replacement.
- Focus on patients with descending aortic aneurysms or chronic dissections.
Purpose of the Study:
- To evaluate the clinical outcomes and long-term efficacy of elective open surgical descending aortic replacement.
- To identify risk factors for late mortality in this patient cohort.
Main Methods:
- Retrospective analysis of 96 patients undergoing elective open descending aortic replacement between 2000 and 2019.
- Data collected on perioperative outcomes, survival rates, and complications.
- Cox proportional hazards regression used to identify mortality risk factors.
Main Results:
- Low in-hospital mortality (3.1%) and acceptable rates of postoperative renal insufficiency (10.8%), stroke (1%), and paraplegia (1%).
- 5- and 10-year survival rates were 70.8% and 50.7%, respectively.
- Age, diabetes, and COPD identified as significant risk factors for late mortality.
Conclusions:
- Elective open surgical descending aortic replacement offers excellent perioperative results.
- Prosthetic grafts demonstrate safety and efficacy for long-term use in descending aortic replacement.
Background:
This study presents a single center's experience and analyzes clinical outcomes following elective open surgical descending aortic replacement.
Methods:
Between January 2000 and August 2019, 96 patients with mean age 64 years (range, 49.5-71 years) (62.5% (n=60) male) underwent elective descending aortic replacement due to aneurysm (n=60) or chronic dissection (n=36). Marfan syndrome was present in 12 patients (12.5%).
Results:
In-hospital mortality rate was 3.1% (n= 3. 2 in the aneurysm group, 1 in the dissection group). New-onset renal insufficiency postoperatively with (creatinine ≥ 2.5 mg/dl) manifested in 10 patients (10.8%). One patient (1%) suffered from stroke, and paraplegia developed in 1 pts (1%). The median follow-up time was 7 years (IQR: 2.5-13 years). The 5- and 10-year survival rates were 70.8% and 50.7% respectively. We did not observe any early or late prosthetic graft infection. The Cox proportional hazards regression analysis identified age (HR: 1.044, 95% CI: 1.009-1.080, p-value: 0.014), diabetes (HR: 2.544, 95% CI: 1.009-6.413, p-value: 0.048), and chronic obstructive pulmonary disease (COPD) (HR: 2.259, 95% CI: 1.044-4.890, p-value: 0.039) as risk factors for late mortality.
Conclusions:
This study showed that the elective open surgical replacement of the descending aorta can be achieved with excellent outcomes in terms of perioperative mortality and morbidity. Prosthetic graft is not a problem with open surgical descending aortic replacement, even in the long term.
Supplementary Information:
The online version contains supplementary material available at 10.1007/s12055-022-01443-x.
