title: Technical advances improved outcome in patients undergoing surgery of the ascending aorta and/or aortic arch: ten years experience.
abstract: BACKGROUND
  Several technical advances in thoracic aortic surgery, such as the use of antegrade cerebral perfusion, avoidance of cross-clamping and the application of glue, have beneficially influenced postoperative outcome. The aim of the present study was to analyse the impact of these developments on outcome of patients undergoing surgery of the thoracic aorta.
  
  
  RESULTS
  Between January 1996 and December 2005, 835 patients (37.6%) out of 2215 aortic patients underwent surgery on the thoracic ascending aorta or the aortic arch at our institution. All in-hospital data were assessed. Two hundred and forty-one patients (28.8%) suffered from acute type A dissection (AADA). Overall aortic caseload increased from 41 patients in 1996 to 141 in 2005 (+339%). The increase was more pronounced for thoracic aortic aneurysms (TAA) (+367.9%), than for acute type A aortic dissections (+276.9%). Especially in TAA, combined procedures increased and the amount of patients with impaired left ventricular function (EF <50%) raised up from 14% in 1996 to 24% in 2005. Average age remained stable. Logistic regression curve revealed a significant decrease in mortality (AADA) and in the overall incidence of neurological deficits.
  
  
  CONCLUSIONS
  Technical advances in the field of thoracic aortic surgery lead to a decrease of mortality and morbidity, especially in the incidence of adverse neurological events, in a large collective of patients. Long-term outcome and quality of life are better, since antegrade cerebral perfusion has been introduced.
authors.affiliation: Department of Cardiovascular Surgery, University Hospital, 3010 Berne, Switzerland.
authors.forename: Eva S
authors.initials: ES
authors.lastname: Krähenbühl
authors.forename: Franz F
authors.initials: FF
authors.lastname: Immer
authors.forename: Mario
authors.initials: M
authors.lastname: Stalder
authors.forename: Lars
authors.initials: L
authors.lastname: Englberger
authors.forename: Friedrich S
authors.initials: FS
authors.lastname: Eckstein
authors.forename: Jürg
authors.initials: J
authors.lastname: Schmidli
authors.forename: Thierry P
authors.initials: TP
authors.lastname: Carrel
mesh_terms: D000208:Acute Disease; D000368:Aged; D000784:Aortic Dissection / Q000601:surgery*; D001011:Aorta / Q000601:surgery; D001013:Aorta, Thoracic / Q000601:surgery; D001014:Aortic Aneurysm / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods* / Q000639:trends; D002560:Cerebrovascular Circulation; D002561:Cerebrovascular Disorders / Q000209:etiology / Q000517:prevention & control; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods; D007430:Intraoperative Care / Q000379:methods; D008297:Male; D008875:Middle Aged; D010477:Perfusion / Q000379:methods; D016896:Treatment Outcome