Aim: To investigate major in-hospital complications of ascending aorta reconstruction and to identify factors associated with these complications. Methods All consecutive patients admitted to our clinic for aortic aneurysm repair from June 2005 to June 2009 were enrolled in this retrospective study. Demographic data, details of the surgical procedures and major in-hospital complications were assessed and recorded from the institutional electronic database. Patients were divided into two groups according to the development of major in-hospital complications. Results The New York Heart Association (NYHA) Class of patients with major in-hospital complications was higher than those without complications. In addition, the number of patients with coronary artery disease (CAD), diabetes, chronic renal disease (CRD), chronic obstructive pulmonary disease (COPD), and previous cardiac surgery was significantly higher in those with major in-hospital complications. Moreover, the requirement for inotropic agents and intra-aortic balloon pump was higher in these patients. Cross-clamp time was significantly higher in patients with major in-hospital complications (107±34 vs. 79±26 (p<0.001). Presence of CRD (r=0.308; p=0.005) and CAD (r=0.244; p=0.028), previous cardiac surgery (r=0.266; p=0.022), cross-clamp time (r=0.349; p=0.001) and IABP requirement (r=0.308; p=0.005) were significantly correlated with the development of major in-hospital complications. Conclusion Our results show that presence of underlying CRD and CAD, previous cardiac surgery, length of cross-clamp time and IABP requirement were significantly associated with the development of in-hospital complications in patients undergoing surgical reconstruction for ascending aortic aneurysm.
Van Duffel D, Gemert V, Starinieri R, Pauwels P, Natukunda J, Rakhmawati A, et al. Elective reconstruction of the ascending aorta for aneurysmal disease restores normal life expectancy. An analysis of risk factors for early and late mortality. Acta Cardiol. 2013;349–53.
2.
Chau K, Elefteriades J. Natural history of thoracic aortic aneurysms: size matters, plus moving beyond size. Prog Cardiovasc Dis. 2013;74–80.
3.
Ho N, Mohadjer A, Desai M. Thoracic aortic aneurysms: state of the art and current controversies. Expert Rev Cardiovasc Ther. 2017;667–80.
4.
Clare R, Jorgensen J, Brar S. Open versus endovascular or hybrid thoracic aortic aneurysm repair. Curr Atheroscler Rep. 2016;60.
5.
Gott V, Greene P, Alejo D, Naftel C, Miller D, Gillinov D, et al. Replacement of the aortic root in patients with Marfan’s syndrome. N Engl J Med. 1999;1307–13.
6.
David T, Feindel C, David C, Manlhiot C. A quarter of a century of experience with aortic valvesparing operations. J Thorac Cardiovasc Surg. 2014;9–80.
7.
Kaneko T, Aranki S, Neely R, Yazdchi F, Mcgurk S, Leacche M, et al. Is there a need for adjunct cerebral protection in conjunction with deep hypothermic circulatory arrest during noncomplex hemiarch surgery? J Thorac Cardiovasc Surg. 2014;2911–7.
8.
Bloodwell R, Hallman G, Cooley D. Total replacement of the aortic arch and the “subclavian steal” phenomenon. Ann Thorac Surg. 1968;236–45.
9.
Borst H, Walterbusch G, Schaps D. Extensive aortic replacement using "elephant trunk. prosthesis Thorac Cardiovasc Surg. 1983;37–40.
10.
Rokkas C, Kouchoukos N. Single-stage extensive replacement of the thoracic aorta: the arch-first technique. J Thorac Cardiovasc Surg. 1999;99–105.
11.
Benke K, Agg B, Szabo L, Szilveszter B, Odler B, Polos M, et al. Bentall procedure: quarter century of clinical experiences of a single surgeon. J Cardiothorac Surg. 2016;19.
12.
Mookhoek A, Korteland N, Arabkhani B, Centa D, Lansac I, Bekkers E, et al. Bentall procedure: a systematic review and meta-analysis. Ann Thorac Surg. 2016;1684–9.
13.
Ziganshin B, Elefteriades J. Treatment of Thoracic Aortic Aneurysm: Role of earlier intervention. Semin Thorac Cardiovasc Surg. 2015;135–43.
14.
Nishimura R, Otto C, Bonow R, Carabello B, Erwin J, Guyton R, et al. AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;2438–88.
15.
Avgerinos D, Ecomment. Endovascular ascending aortic aneurysm repair: an effective alternative to open repair? Interact Cardiovasc Thorac Surg. 2013;919.
16.
Hori D, Okamura H, Yamamoto T, Nishi S, Yuri K, Kimura N, et al. Early and midterm outcomes of endovascular and open surgical repair of non-dissected aortic arch aneurysmdagger. Interact Cardiovasc Thorac Surg. 2017;944–50.
17.
Khullar V, Schaff H, Dearani J, Daly R, Greason K, Joyce L, et al. Open surgical repair remains the Gold Standard for treating aortic arch pathology. Ann Thorac Surg. 2017;1413–20.
18.
Pan E, Kyto V, Savunen T, Gunn J. Early and late outcomes after open ascending aortic surgery: 47year experience in a single centre. Heart Vessels. 2018;427–33.
19.
Schaffer J, Lingala B, Fischbein M, Dake M, Woo Y, Mitchell R, et al. Midterm outcomes of open descending thoracic aortic repair in more than 5,000 medicare patients. Ann Thorac Surg. 2015;2087–94.
20.
Gaudino M, Lau C, Munjal M, Avgerinos D, Girardi L. Contemporary outcomes of surgery for aortic root aneurysms: a propensity-matched comparison of valve-sparing and composite valve graft replacement. J Thorac Cardiovasc Surg. 2015;1120–9.
21.
Dunne B, Marr T, Andrews D, Larbalestier R, Edwards M, Merry C. Aortic root replacement for ascending aortic disease: a 10 year review. Heart Lung Circ. 2013;81–7.
22.
Prifti E, Bonacchi M, Frati G, Proietti P, Giunti G, Babatasi G, et al. Early and long-term outcome in patients undergoing aortic root replacement with composite graft according to the Bentall’s technique. Eur J Cardiothorac Surg. 2002;15–21.
23.
Sioris T, David T, Ivanov J, Armstrong S, Feindel C. Clinical outcomes after separate and composite replacement of the aortic valve and ascending aorta. J Thorac Cardiovasc Surg. 2004;260–5.
The statements, opinions and data contained in the journal are solely those of the individual authors and contributors and not of the publisher and the editor(s). We stay neutral with regard to jurisdictional claims in published maps and institutional affiliations.
