title: Re-operations on the proximal thoracic aorta: results and predictors of short- and long-term mortality in a series of 174 patients.
abstract: OBJECTIVE
  The aim of this study was to report results and to identify predictors of hospital and long-term mortality in patients undergoing re-operations on the proximal thoracic aorta.
  
  
  METHODS
  Between 1986 and 2009,174 re-operations on the proximal thoracic aorta after previous aortic surgery were performed in our Institution. The patients' mean age was 58 years, 132 (75.9%) were men. The mean time from last operation was 9.9 years. An urgent operation was performed in 35 (20.1%) patients. Indications for surgery included degenerative and chronic post-dissection aneurysm (n=133), acute dissection (n=8), false aneurysm (n=22), and active prosthetic infection (n=11). Root procedures were performed in 65 (37.3%) patients, ascending aorta replacement in 27 (15.5%), different extents of aortic arch replacement in 39 (22.4%), and root, ascending aorta and arch replacement in 43 (24.7%).
  
  
  RESULTS
  Hospital mortality was 12.6%. On multivariate analysis, cardiopulmonary bypass (CPB) time (odds ratio (OR)=1.1018 per min), New York Heart Association (NYHA) class III-IV (OR=3.86), and active endocarditis (OR=5.15) emerged as independent predictors of hospital mortality. Mean follow-up time was 56 months. The estimated 1-, 5-, and 10 years' survival were 81.6%, 74.2%, and 44.5%, respectively. On Cox regression analysis, age (hazard ratio (HR)=1.037 per year) and CPB time (HR=1.010 per min) emerged as independent risk factors of late mortality.
  
  
  CONCLUSIONS
  Short- and long-term survival was satisfactory being excellent in patients with degenerative aneurysms and dismal in those with active endocarditis. Extensive aortic resections did not increase hospital mortality and were associated with a reduced need for aortic re-interventions. CPB time remains the most important risk factor for reduced survival in aortic surgery.
authors.affiliation: Cardiac Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy. marco.dieusanio2@unibo.it
authors.forename: Marco
authors.initials: M
authors.lastname: Di Eusanio
authors.forename: Paolo
authors.initials: P
authors.lastname: Berretta
authors.forename: Luca
authors.initials: L
authors.lastname: Bissoni
authors.forename: Francesco D
authors.initials: FD
authors.lastname: Petridis
authors.forename: Luca
authors.initials: L
authors.lastname: Di Marco
authors.forename: Roberto
authors.initials: R
authors.lastname: Di Bartolomeo
mesh_terms: D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000601:surgery; D017541:Aneurysm, False / Q000601:surgery; D001013:Aorta, Thoracic / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery; D001018:Aortic Diseases / Q000601:surgery*; D001021:Aortic Valve / Q000601:surgery; D001807:Blood Vessel Prosthesis / Q000009:adverse effects; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods; D002315:Cardiopulmonary Bypass; D004812:Epidemiologic Methods; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016459:Prosthesis-Related Infections / Q000601:surgery; D012086:Reoperation / Q000379:methods; D016896:Treatment Outcome