[Surgery of the ascending aorta: the 1984-1995 experience of the cardiac surgery teaching unit in the University of Milan. Multivariate analysis of its risk factors for hospital mortality and reduced long-term survival].
Between 1984 and 1995, 183 patients underwent an ascending aorta procedure at our institution. Their mean age was 60 +/- 12.3 years; 116 (63.4%) patients were male, 35 (19.1%) had a history of congestive heart failure, 72 (39.3%) presented acute type A dissection, 23 (12.6%) were redos and 63 (34.4%) were operated on an emergency basis. In-hospital mortality was 10% (12/120) in elective procedures and 36.5% (23/63) in emergency operations (p < 0.0001). Multivariate stepwise logistic regression analysis identified cardiopulmonary by-pass time, emergency operation, arch replacement and the need for femoral vein cannulation at surgery as independent predictors of in-hospital death. Mean follow-up time was 54 +/- 30 months (median 50 months), with a Kaplan-Meier survival of 69 +/- 4% and of 60 +/- 5% at 5 and 7 years, respectively. Cox regression analysis identified arch replacement, perioperative myocardial infarction, preoperative NYHA class, acute type A aortic dissection, the need for femoral vein cannulation at intervention and redo operations as independent predictors of reduced survival at follow-up. When this kind of analysis was performed on hospital survivors only, postoperative tracheostomy, reexploration for bleeding, and the occurrence of postoperative ventricular arrhythmias emerged as risk factors. In conclusion, multiple factors affect both early and long-term outcome following ascending aorta surgery. Preoperative clinical status of patients, priority of surgery and aortic dissection are the main determinants of the short-term results. Otherwise, in hospital survivors, the main determinant for long-term outcome seems to be the immediate postoperative course.
Spirito
R
R
Cattedra di Cardiochirurgia, Università degli Studi di Milano, Fondazione I. Monzino IRCCS.
Musumeci
S
S
Parolari
A
A
Porqueddu
M
M
Dainese
L
L
Agrifoglio
M
M
Antona
C
C
Alamanni
F
F
Biglioli
P
P
D000368:Aged; D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery*; D001011:Aorta / Q000601:surgery*; D001014:Aortic Aneurysm / Q000401:mortality / Q000601:surgery*; D001021:Aortic Valve / Q000601:surgery; D001807:Blood Vessel Prosthesis; D017558:Elective Surgical Procedures; D004630:Emergencies; D005260:Female; D017052:Hospital Mortality; D006784:Hospitals, Teaching; D006801:Humans; D007558:Italy; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome