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Surgical and long-term mortality in 2634 consecutive patients operated on the proximal thoracic aorta
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, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , UCR-Uppsala Clinical Research Center.
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.
2007 (English)In: European Journal of Cardio-Thoracic Surgery, ISSN 1010-7940, E-ISSN 1873-734X, Vol. 31, no 6, 963-969 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To assess surgical and long-term mortality in a large, contemporary, unselected cohort of patients undergoing operations on the proximal thoracic aorta. Methods: Patients in the Swedish Heart Surgery register operated 1992-2004 were identified and data cross-linked with the in-hospital and cause-of-death registers. Factors associated with surgical, intermediate, and long-term mortality were studied with separate Cox analyses. Long-term survival was estimated by Kaplan-Meier analysis. Results: 2634 patients (68% men, mean age 60 years) were operated for aortic aneurysm (n = 1821, 69%) or aortic dissection (n = 813, 31%). Overall, increased age, aortic dissection, emergency operation, coronary artery bypass grafting, postoperative stroke, and postoperative renal failure were independently associated with surgical mortality. Only age was independently associated with long-term mortality. Later era of treatment (1998-2004 vs 1992-1997) was associated with lower risk only for aneurysm patients, despite similar changes in surgical approach. Long-term survival for all patients was 83% at 1 year, 77% at 5 years, and 73% at 10 years and identical for aneurysm and dissection when adjusted for surgical mortality. Conclusions: Increased age was associated with increased mortality across follow-up, implicating early surgery when possible. Results improved over time for aneurysms but not dissections; however, long-term survival was equal.

Place, publisher, year, edition, pages
2007. Vol. 31, no 6, 963-969 p.
Keyword [en]
Aneurysm, Aortic, Risk factors, Surgery, Survival
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-13838DOI: 10.1016/j.ejcts.2007.01.034ISI: 000247290300001PubMedID: 17336538OAI: oai:DiVA.org:uu-13838DiVA: diva2:41608
Available from: 2008-01-28 Created: 2008-01-28 Last updated: 2017-12-11Bibliographically 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.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 155
Keyword
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
Identifiers
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
Opponent
Supervisors
Available from: 2006-05-10 Created: 2006-05-10 Last updated: 2011-04-12Bibliographically approved

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Olsson, ChristianStåhle, ElisabethThelin, Stefan

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