title: Elective surgery for thoracic aortic aneurysms: late functional status and quality of life.
abstract: BACKGROUND
  Elective surgical treatment for thoracic aortic aneurysms is unique in that it is often performed on asymptomatic patients. Although it has been found to improve survival, the impact of elective surgery on late functional status and quality of life have yet to be examined.
  
  
  METHODS
  Over a 5-year period, 110 asymptomatic patients underwent elective thoracic aortic replacement for ascending, descending, or thoracoabdominal aneurysms. Mean age was 67 +/- 9 years (53 > or = 70 years). Functional status, physical and psychological quality of life (Medical Outcome Study 36-Item Short Form Health Survey, in which 50 represents normalized age-matched US population), and survival (Kaplan-Meier) were assessed.
  
  
  RESULTS
  Return to normal activity level was independent of age (p > 0.59) and procedure (p > 0.18). At 35 +/- 20 months, psychological quality of life was similar between surgical groups (p > 0.71), but physical quality of life was lower after thoracoabdominal versus ascending or descending aneurysms (p < 0.02). Age did not impact physical quality of life (40 +/- 13 > or = 70 years versus 42 +/- 11 < 70 years, p > 0.58), but older patients had improved psychological quality of life (52 +/- 9 > or = 70 years versus 47 +/- 8 < 70 years, p > 0.03). Overall survival was 79% +/- 4% at 2 years and 70% +/- 5% at 4 years, but was lower with thoracoabdominal versus ascending or descending aneurysms (p < 0.002). Multivariate analysis identified thoracoabdominal (p < 0.004), advanced age (p < 0.03), chronic renal failure (p < 0.03), and congestive heart failure (p < 0.001) as predictors of late death.
  
  
  CONCLUSIONS
  Advanced age did not impair return to normal functional status, and older patients had improved psychological quality of life. Survival and physical quality of life were lowest with thoracoabdominal versus ascending or descending aneurysms. Thus, patients with asymptomatic thoracic aneurysms should not be denied elective replacement based on age alone, as functional recovery was not significantly impaired.
authors.affiliation: Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri 63110-1013, USA.
authors.forename: Andreas
authors.initials: A
authors.lastname: Zierer
authors.forename: Spencer J
authors.initials: SJ
authors.lastname: Melby
authors.forename: Jordon G
authors.initials: JG
authors.lastname: Lubahn
authors.forename: Gregorio A
authors.initials: GA
authors.lastname: Sicard
authors.forename: Ralph J
authors.initials: RJ
authors.lastname: Damiano
authors.forename: Marc R
authors.initials: MR
authors.lastname: Moon
mesh_terms: D000368:Aged; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000523:psychology / Q000601:surgery*; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011788:Quality of Life; D012189:Retrospective Studies