Outcome and risk factors in surgery of descending thoracic aneurysms.
In a series of 100 consecutive patients operated upon for aneurysmatic lesions of the descending thoracic aorta, the mean age was 52 +/- 16 years (male = 81, female = 19). There were 31 dissections (acute 10, chronic 21); 28 post-traumatic aneurysms (ruptured 5, acute 7, chronic 16); 22 arteriosclerotic aneurysms (ruptured 1, chronic 21); 11 thoracoabdominal aneurysms, 5 anastomotic aneurysms and 3 mycotic aneurysms. No symptomatic patient was refused. Preoperative risk factors were graded on a scale of 6 by counting 1 point for each of the following elements: central nervous system disease; heart, pulmonary, and renal disease; arterial hypertension, age greater than 60. In-hospital mortality and paraplegia for the whole series were 25% and 7% respectively. In acute dissection, the mortality was 6/10 patients versus 2/21 in chronic events. In post-traumatic aneurysms, mortality was 2/5 in ruptured, 2/7 in acute and 0/16 in chronic events. In arteriosclerotic aneurysms, mortality was 1/2 in ruptured and 6/20 in chronic events. In thoracoabdominal aneurysms, mortality was 5/11, in anastomotic 1/5 and in mycotic 0/3 patients. The mean number of risk factors in non-survivors versus survivors was significantly higher in acute dissection, chronic dissection, chronic arteriosclerotic aneurysms and thoracoabdominal aneurysms. Rupture and acute events are related to a high surgical mortality. Non-survivors appear to have significantly more preoperative risk factors.
von Segesser
L
L
Department of Cardiovascular Surgery, University Hospital, Zurich, Switzerland.
Burki
H
H
Schneider
K
K
Siebenmann
R
R
Schmid
E R
ER
Turina
M
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D001013:Aorta, Thoracic / Q000601:surgery; D001014:Aortic Aneurysm / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010264:Paraplegia / Q000453:epidemiology; D011183:Postoperative Complications / Q000401:mortality; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors