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Long-term survival and frequency of reinterventions after proximal aortic surgery: a retrospective study
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Thoracic Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Thoracic Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Thoracic Surgery.ORCID iD: 0000-0001-9111-115X
2019 (English)In: European Journal of Cardio-Thoracic Surgery, ISSN 1010-7940, E-ISSN 1873-734X, Vol. 56, no 4, p. 722-730Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: We sought to analyse perioperative outcome, long-term mortality, frequency and causes of reintervention, and survival benefit in a contemporary cohort of patients undergoing proximal thoracic aortic surgery.

METHODS: Participants comprised all patients undergoing open surgery for proximal thoracic aortic aneurysm (TAA) (n=319) and thoracic aortic dissection type A (TAD) (n=229) during 2005-2014 at the Department of Thoracic Surgery, Uppsala University Hospital. Long-term survival was compared to age- and sex-matched controls. Perioperative mortality and morbidity, event-free survival and causes of reoperation were also analysed.

RESULTS: Long-term mortality was normalized in patients with TAA, and a survival benefit was seen as early as 20 months when corrected for time lost due to perioperative mortality. Long-term survivors undergoing surgery for TAD, on the other hand, had a 10-year mortality of 130% [95% confidence interval (95% CI) 120-140%] compared to age- and sex-matched controls. Moreover, their event-free survival was half that of patients with TAA (hazard ratio 2.3; 95% CI 1.7-3.2). Reintervention (i.e. reoperation or thoracic endovascular aortic repair) was also twice as common in the TAD patients (odds ratio 2.0; 95% CI 1.1-3.5). The dominant causes for reoperation among TAD patients were aortic insufficiency, aortic arch aneurysm and infection.

CONCLUSIONS: Surgery for TAA is relatively safe, normalizes long-term mortality and confers an early survival benefit. However, TAD surgery carries a high risk of perioperative mortality and morbidity, as well as increased long-term mortality and risk of reintervention.

Place, publisher, year, edition, pages
2019. Vol. 56, no 4, p. 722-730
Keywords [en]
Aortic dissection, Aortic aneurysm, Surgery, Survival, Reintervention
National Category
Surgery
Identifiers
URN: urn:nbn:se:uu:diva-396734DOI: 10.1093/ejcts/ezz073ISI: 000491248300012PubMedID: 30879026OAI: oai:DiVA.org:uu-396734DiVA, id: diva2:1373290
Conference
32nd Annual Meeting of the European-Association-for-Cardio-Thoracic-Surgery, OCT 18-20, 2018, Milan, ITALY
Available from: 2019-11-26 Created: 2019-11-26 Last updated: 2019-11-26Bibliographically approved

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Vikholm, PerThelin, Stefan

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