title: Long-term results after proximal thoracic aortic redo surgery.
abstract: OBJECTIVE
  To evaluate early and mid-term results in patients undergoing proximal thoracic aortic redo surgery.
  
  
  METHODS
  We analyzed 60 patients (median age 60 years, median logistic EuroSCORE 40) who underwent proximal thoracic aortic redo surgery between January 2005 and April 2012. Outcome and risk factors were analyzed.
  
  
  RESULTS
  In hospital mortality was 13%, perioperative neurologic injury was 7%. Fifty percent of patients underwent redo surgery in an urgent or emergency setting. In 65%, partial or total arch replacement with or without conventional or frozen elephant trunk extension was performed. The preoperative logistic EuroSCORE I confirmed to be a reliable predictor of adverse outcome- (ROC 0.786, 95%CI 0.64-0.93) as did the new EuroSCORE II model: ROC 0.882 95%CI 0.78-0.98. Extensive individual logistic EuroSCORE I levels more than 67 showed an OR of 7.01, 95%CI 1.43-34.27. A EuroSCORE II larger than 28 showed an OR of 4.44 (95%CI 1.4-14.06). Multivariate logistic regression analysis identified a critical preoperative state (OR 7.96, 95%CI 1.51-38.79) but not advanced age (OR 2.46, 95%CI 0.48-12.66) as the strongest independent predictor of in-hospital mortality. Median follow-up was 23 months (1-52 months). One year and five year actuarial survival rates were 83% and 69% respectively. Freedom from reoperation during follow-up was 100%.
  
  
  CONCLUSIONS
  Despite a substantial early attrition rate in patients presenting with a critical preoperative state, proximal thoracic aortic redo surgery provides excellent early and mid-term results. Higher EuroSCORE I and II levels and a critical preoperative state but not advanced age are independent predictors of in-hospital mortality. As a consequence, age alone should no longer be regarded as a contraindication for surgical treatment in this particular group of patients.
authors.affiliation: Department of Cardiovascular Surgery, University Hospital Berne, Berne, Switzerland. martin.czerny@insel.ch
authors.forename: Martin
authors.initials: M
authors.lastname: Czerny
authors.forename: Ilan
authors.initials: I
authors.lastname: Barchichat
authors.forename: Katharina
authors.initials: K
authors.lastname: Meszaros
authors.forename: Gottfried H
authors.initials: GH
authors.lastname: Sodeck
authors.forename: Alberto
authors.initials: A
authors.lastname: Weber
authors.forename: David
authors.initials: D
authors.lastname: Reineke
authors.forename: Lars
authors.initials: L
authors.lastname: Englberger
authors.forename: Florian
authors.initials: F
authors.lastname: Schönhoff
authors.forename: Alexander
authors.initials: A
authors.lastname: Kadner
authors.forename: Hansjörg
authors.initials: H
authors.lastname: Jenni
authors.forename: Jürg
authors.initials: J
authors.lastname: Schmidli
authors.forename: Thierry P
authors.initials: TP
authors.lastname: Carrel
mesh_terms: D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D001013:Aorta, Thoracic / Q000473:pathology / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012086:Reoperation; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome