title: Impact of pre-existing conditions, age and the length of cardiopulmonary bypass on postoperative outcome after repair of the ascending aorta and aortic arch for aortic aneurysms and dissections.
abstract: BACKGROUND
  Repair of the ascending aorta and aortic arch carries a high morbidity and mortality, which can be complicated by the often emergent nature of the intervention.
  
  
  METHODS
  We retrospectively evaluated the morbidity, mortality, and long-term survival in 101 patients who underwent repair of ascending aorta and aortic arch. Depending on the urgency of the operation, the patients were categorized as elective (EL, n=82) or emergent (EM, n=19). Log-rank-list and SPS were used to evaluate the data.
  
  
  RESULTS
  The average age was 58+/-16 years. The aortic diameter was 5.5+/-1 cm in the EL group and 6.1+/-1.4 cm for EM group. The aortic dissection in EL and EM groups was 15% and 79%, respectively. The mean circulatory arrest time (n=32 patients) was 38+/-18.5 min. The overall 30-day mortality was 4%: 0% for the EL group and 26% for the EM group. The overall 6-month mortality was 8%: 3.7% and 26% in EL and EM groups, respectively. Overall CVA was 3%: 0% in the EL group and 15.7% in the EM group. The mean CPB time was 176+/-81 min. The prolonged CPB time correlated with increased need for blood transfusion. The LOS was 12+/-8 days and correlated with increasing age (95% CI 0.06860-0.2307, P=0.0004), with NYHA stage of patients at the time of surgery (95% confidence intervals, 1.328-4.202, P=0.0003), with left ventricular ejection fraction (95% CI 0.2357 to -0.003029, P=0.0442) and with postoperative atrial fibrillation (95% CI 0.1192-0.4745, P=0.0018). The average ICU stay was 123+/-145 h. A prolonged CPB time resulted in extended ICU stay (95% CI 0.3655-1.486, P=0.0014). Further, the length of ICU stay correlated with NYHA status (95% CI 19.98-73.42, P=0.0008), age (95% confidence intervals 0.01668-3.761, P=0.0477), urgency of surgery (95% CI 65.00-124.0, P<0.0001), and length of CPB time (95% CI 0.3655-1.486, P=0.0014).
  
  
  CONCLUSIONS
  Emergent operations are associated with high morbidity and mortality. Pre-existing heart failure, advanced age, and prolonged cardiopulmonary bypass are associated with prolonged monitoring in the ICU.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Loyola University Chicago, Stritch School of Medicine, Maywood, IL 60153, USA.
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Schwartz
authors.forename: Mamdouh
authors.initials: M
authors.lastname: Bakhos
authors.forename: Amit
authors.initials: A
authors.lastname: Patel
authors.forename: Sally
authors.initials: S
authors.lastname: Botkin
authors.forename: Siyamek
authors.initials: S
authors.lastname: Neragi-Miandoab
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000784:Aortic Dissection / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000401:mortality; D004638:Emergency Treatment; D005260:Female; D006333:Heart Failure / Q000150:complications; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality