Current role and outcomes of ascending aortic replacement for severe nonaneurysmal aortic atherosclerosis.
BACKGROUND
Severe atherosclerosis of the ascending aorta is a challenging issue potentially affecting indications for surgery, operative choices, and patients' outcome. No standard treatment has emerged to date, and uncertainties persist about criteria for selecting patients and procedures.


METHODS
Replacement of the atherosclerotic ascending aorta was performed in 64 patients at time of either aortic (n = 49), mitral (n = 21), or tricuspid (n = 7) valve surgery. Coronary artery bypass grafting was performed in 53 patients, and the majority of patients underwent combined procedures (n = 49). Mean age was 72.0 +/- 7.6 years. The expected operative mortality, by logistic European System for Cardiac Operative Risk Evaluation, was 29.0% accounting for ascending aortic replacement and 13.1% disregarding it. Circulatory arrest under deep hypothermia, eventually combined with either retrograde or antegrade brain perfusion, was required in 61 cases.


RESULTS
Early death, stroke, and myocardial infarction rates were 10.9%, 6.3%, and 7.8%, respectively. Factors univariately associated with early deaths were preoperative renal failure requiring dialysis (p = 0.001) and longer cardiopulmonary bypass (p = 0.001) and cardioplegia (p = 0.008) times. Cumulative survival at 1, 3, and 5 years was 86% +/- 4%, 74% +/- 6%, and 68% +/- 8%, respectively.


CONCLUSIONS
Replacement of the atherosclerotic ascending aorta can be carried out at acceptable mortality rates despite the high rates of preoperative comorbidity and the significant incidence of postoperative complications.
Zingone
Bartolo
B
Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy. bartolo.zingone@gmail.com
Gatti
Giuseppe
G
Spina
Amedeo
A
Rauber
Elisabetta
E
Dreas
Lorella
L
Forti
Gabriella
G
Pappalardo
Aniello
A
D058186:Acute Kidney Injury / Q000401:mortality; D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000601:surgery; D001018:Aortic Diseases / Q000401:mortality / Q000601:surgery*; D050197:Atherosclerosis / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D002315:Cardiopulmonary Bypass; D002423:Cause of Death; D003131:Combined Modality Therapy; D001026:Coronary Artery Bypass; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D017052:Hospital Mortality; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality; D012307:Risk Factors; D020521:Stroke / Q000401:mortality; D015996:Survival Rate