title: Contemporary results for proximal aortic replacement in North America.
abstract: OBJECTIVE
  The purpose of this study was to characterize operative outcomes for ascending aorta and arch replacement on a national scale and to develop risk models for mortality and major morbidity.
  
  
  BACKGROUND
  Contemporary outcomes for ascending aorta and arch replacement in North America are unknown.
  
  
  METHODS
  We queried the Society of Thoracic Surgeons Database for patients undergoing ascending aorta (with or without root) with or without arch replacement from 2004 to 2009. The database captured 45,894 cases, including 12,702 root, 22,048 supracoronary ascending alone, 6,786 ascending plus arch, and 4,358 root plus arch. Baseline characteristics and clinical outcomes were analyzed. A parsimonious multivariable logistic regression model was constructed to predict risks of mortality and major morbidity.
  
  
  RESULTS
  Operative mortality was 3.4% for elective cases and 15.4% for nonelective cases. A risk model for operative mortality (c-index 0.81) revealed a risk-adjusted odds ratio for death after emergent versus elective operation of 5.9 (95% confidence interval: 5.3 to 6.6). Among elective patients, end-stage renal disease and reoperative status were the strongest predictors of mortality (adjusted odds ratios: 4.0 [95% confidence interval: 2.6 to 6.4] and 2.3 (95% confidence interval: 1.9 to 2.7], respectively; p < 0.0001).
  
  
  CONCLUSIONS
  Current outcomes for ascending aorta and arch replacement in North America are excellent for elective repair; however, results deteriorate for nonelective status, suggesting that increased screening and/or lowering thresholds for elective intervention could potentially improve outcomes. The predictive models presented may serve clinicians in counseling patients.
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: Judson B
authors.initials: JB
authors.lastname: Williams
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.forename: Yue
authors.initials: Y
authors.lastname: Zhao
authors.forename: Sean M
authors.initials: SM
authors.lastname: O'Brien
authors.forename: Nicholas D
authors.initials: ND
authors.lastname: Andersen
authors.forename: D Craig
authors.initials: DC
authors.lastname: Miller
authors.forename: Edward P
authors.initials: EP
authors.lastname: Chen
authors.forename: G Chad
authors.initials: GC
authors.lastname: Hughes
mesh_terms: D000368:Aged; D001011:Aorta / Q000601:surgery*; D001018:Aortic Diseases / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000401:mortality*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009656:North America; D011183:Postoperative Complications / Q000401:mortality; D018570:Risk Assessment; D016896:Treatment Outcome