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Thoracic aortic aneurysms and dissections: increasing incidence and improving results: A natiowide population-based study of over 14000 cases in Sweden 1987-2002
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Thoracic Surgery.
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2006 (English)Other (Other academic)
Place, publisher, year, edition, pages
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Medical and Health Sciences
URN: urn:nbn:se:uu:diva-94549OAI: oai:DiVA.org:uu-94549DiVA: diva2:168431
Available from: 2006-05-10 Created: 2006-05-10 Last updated: 2010-11-12Bibliographically approved
In thesis
1. Thoracic Aortic Surgery: Epidemiology, Outcomes, and Prevention of Cerebral Complications
Open this publication in new window or tab >>Thoracic Aortic Surgery: Epidemiology, Outcomes, and Prevention of Cerebral Complications
2006 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The mortality of thoracic aortic diseases (mainly aneurysms and dissections) is high, even with surgical treatment. Epidemiology and long-term outcomes are incompletely investigated. Stroke is a major complication contributing to mortality, morbidity, and possibly to reduced quality of life.

Study I Increasing incidence of thoracic aortic diseases 1987 – 2002 was demonstrated (n=14229). Annual number of operations increased eight-fold. Overall long-time survival was 92%, 77%, and 57% at 1, 5, and 10 years. Risk of operative and long-term mortality was reduced across time.

Study II 2634 patients operated on the proximal thoracic aorta (Swedish Heart Surgery register) were examined. Aortic valve replacement, coronary revascularization, emergency operation, and age were independently associated with surgical death. Long-term mortality was similar for aneurysms and dissections. Operative mortality was reduced (13.7% vs 7.2%) for aneurysms but remained unchanged (22.3% vs 22.4%) for dissections across time.

Study III 65 patients underwent selective antegrade cerebral perfusion (SACP) uni- or bilaterally. Stroke was significantly more common after unilateral SACP (29% vs 8%, p=0.045), confirmed by propensity score-matched analysis. Subclavian artery cannulation with Seldinger-technique entailed vascular complication in one case (1.5%).

Study IV Near-infrared spectroscopy (NIRS) was used to monitor cerebral tissue saturation (rSO2) during SACP in 46 patients. Lower rSO2 were encountered (1) in patients suffering a stroke (2) with unilateral SACP, and (3) in the affected hemisphere of stroke victims. A decrease of rSO2 by 14 – 21% from baseline increased the risk of stroke significantly.

Study V Quality of life (QoL) in 76 survivors of thoracic aortic surgery was examined with the SF-36 health questionnaire. Except for pain, QoL was reduced in all dimensions. QoL was not affected by acuity of operation. Tendencies of lower QoL after descending aortic operations, after major complications, and with persistent dysfunction were non-significant.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2006. 83 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 155
Surgery, Aorta, Thoracic, Aortic aneurysms, Aortic disease, Cardiovascular surgical procedures, Epidemiology, Registries, Treatment outcome, Survival analysis, Cerebral infarction, Near-infrared spectroscopy, Quality of life, Perfusion, Kirurgi
urn:nbn:se:uu:diva-6899 (URN)91-554-6579-X (ISBN)
Public defence
2006-05-31, Robergsalen, Akademiska sjukhuset, Ingång 40, Uppsala, 13:15
Available from: 2006-05-10 Created: 2006-05-10 Last updated: 2011-04-12Bibliographically approved

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