title: Diabetes and evidence of atherosclerosis are major risk factors for adverse outcome after elective thoracic aortic surgery.
abstract: BACKGROUND
  To predict risk after elective repair of ascending aorta and aortic arch aneurysms, we studied 464 consecutive patients.
  
  
  METHODS
  Adverse outcome (stroke or hospital death) was analyzed in 372 patients who underwent proximal repair and 92 patients who underwent aortic arch replacement from 1986 to the present. Preoperative risk factors with a P value less than.2 in a univariate analysis were entered into a multivariate model, and an equation incorporating independent risk factors was derived separately for proximal aorta and arch surgery.
  
  
  RESULTS
  Age more than 65 years (P =.04), diabetes (P =.02), cause (P =.01), and prolonged total cerebral protection time (duration of hypothermic circulatory arrest and selective cerebral perfusion, P =.001) were significant univariate risk factors for elective proximal aortic repair. Diabetes (P =.005, odds ratio 5.1), atherosclerosis (P =.003, odds ratio 4.0), and dissection (P =.048, odds ratio 2.5) were independent factors. For elective arch surgery, female sex (P =.07), age more than 65 years (P =.04), coronary artery disease (P =.02), diabetes (P =.06), cause (P =.07), and prolonged total cerebral protection time (P =.025) were univariate risk factors. Female sex (P =.05, odds ratio 4.7), coronary artery disease (P =.02, odds ratio 6.5), diabetes (P =.13, odds ratio 4.0), and total cerebral protection time (P =.03, odds ratio 1.02/min) were independent factors. To calculate risk of adverse outcome (P), enter 1 if factor is present, 0 if absent, and estimate total cerebral protection time (in minutes). [equation: see text].
  
  
  CONCLUSIONS
  In this large series of patients, the presence of diabetes and manifestations of atherosclerosis emerge as extremely important risk factors for adverse outcome after ascending aorta or arch surgery, displacing age. Multivariate equations derived from these data allow more precise calculation of risk for each individual contemplating elective surgery.
authors.affiliation: Hannover Medical School, Department of Thoracic and Cardiovascular Surgery, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany. chagl@hotmail.com
authors.forename: Christian
authors.initials: C
authors.lastname: Hagl
authors.forename: Jan D
authors.initials: JD
authors.lastname: Galla
authors.forename: David
authors.initials: D
authors.lastname: Spielvogel
authors.forename: Carol
authors.initials: C
authors.lastname: Bodian
authors.forename: Steven L
authors.initials: SL
authors.lastname: Lansman
authors.forename: Rafael
authors.initials: R
authors.lastname: Squitieri
authors.forename: M Arisan
authors.initials: MA
authors.lastname: Ergin
authors.forename: Randall B
authors.initials: RB
authors.lastname: Griepp
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000601:surgery*; D001161:Arteriosclerosis / Q000150:complications*; D006348:Cardiac Surgical Procedures / Q000379:methods; D002648:Child; D048909:Diabetes Complications; D017558:Elective Surgical Procedures; D005260:Female; D006324:Heart Arrest, Induced; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012737:Sex Factors; D016896:Treatment Outcome