Contemporary outcomes of open thoracic aortic surgery in a veteran population: do risk models exaggerate mortality?
BACKGROUND
We evaluated contemporary outcomes of open thoracic aortic surgery at a Veterans Affairs (VA) medical center affiliated with a major academic aortic program and examined the predictive value of 2 established cardiac risk models.


METHODS
We retrospectively reviewed all open thoracic aortic operations performed between April 1998 and April 2008 (n = 100). Both the EuroSCORE and the VA Continuous Improvement in Cardiac Surgery Program (CICSP) scores were evaluated.


RESULTS
Procedures included ascending aortic repair (n = 74, 15 with arch repair), descending thoracic repair (n = 11, 1 with arch repair), and thoracoabdominal aortic repair (n = 15). Emergency surgery was necessary in 15 cases, and 19 procedures were reoperations. The patients' logistic EuroSCORE and the CICSP scores were similar (18.7% and 18.2%, respectively), but both scores significantly exceeded the observed operative mortality rate (8.0%, P = .008).


CONCLUSIONS
Good outcomes can be achieved when thoracic aortic surgery is performed at an experienced VA center. The cardiac risk models we examined overpredicted operative mortality.
Bakaeen
Faisal G
FG
Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA. misiakos@med.uoa.gr
Chu
Danny
D
Huh
Joseph
J
LeMaire
Scott A
SA
Soltero
Ernesto R
ER
Petersen
Nancy J
NJ
Sansgiry
Shubhada
S
Lin
Peter
P
Kougias
Panagiotis
P
Shenaq
Salwa
S
Coselli
Joseph S
JS
D000328:Adult; D000368:Aged; D001013:Aorta, Thoracic / Q000601:surgery*; D001018:Aortic Diseases / Q000401:mortality* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D011183:Postoperative Complications / Q000401:mortality*; D012189:Retrospective Studies; D018570:Risk Assessment; D014481:United States; D014656:Vascular Surgical Procedures / Q000379:methods; D014728:Veterans