title: Contemporary outcomes of open thoracic aortic surgery in a veteran population: do risk models exaggerate mortality?
abstract: 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.
authors.affiliation: Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA. misiakos@med.uoa.gr
authors.forename: Faisal G
authors.initials: FG
authors.lastname: Bakaeen
authors.forename: Danny
authors.initials: D
authors.lastname: Chu
authors.forename: Joseph
authors.initials: J
authors.lastname: Huh
authors.forename: Scott A
authors.initials: SA
authors.lastname: LeMaire
authors.forename: Ernesto R
authors.initials: ER
authors.lastname: Soltero
authors.forename: Nancy J
authors.initials: NJ
authors.lastname: Petersen
authors.forename: Shubhada
authors.initials: S
authors.lastname: Sansgiry
authors.forename: Peter
authors.initials: P
authors.lastname: Lin
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Kougias
authors.forename: Salwa
authors.initials: S
authors.lastname: Shenaq
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Coselli
mesh_terms: 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