title: Long-term outcomes after thoracic aortic surgery: a population-based study.
abstract: OBJECTIVE
  Long-term survival after aortic surgery has remained largely unexplored, despite suggestions of superior durability compared with endovascular techniques. The objective of the present study was to determine the long-term survival after open thoracic aortic surgery and to identify the predictors of mortality.
  
  
  METHODS
  The provincial database was accessed to identify all adult patients who had undergone primary open thoracic aortic surgery in British Columbia since 1993. Kaplan-Meier survival analyses were performed for the entire group and by year of surgery, urgency of surgery, and aortic segment requiring surgery. Multivariate analyses were performed to identify the predictors of mortality.
  
  
  RESULTS
  From January 1993 to June 2010, 1960 patients underwent primary open thoracic aortic surgery at 4 hospitals in British Columbia. Overall, the 30-day mortality was 9.1%, with a perioperative stroke rate of 5.8%. Long-term survival was 77.7%, 59.6%, and 44.7% at 5, 10, and 15 years, respectively. Subanalyses demonstrated improved long-term survival in the modern era; among patients undergoing elective aortic surgery; and among patients undergoing surgery on the ascending aorta or aortic root (P < .0001). The preoperative characteristics associated with decreased long-term survival included age older than 65 years, acute renal failure, dialysis, cerebrovascular accident, chronic obstructive pulmonary disease, peripheral vascular disease, and descending or thoracoabdominal aorta surgery.
  
  
  CONCLUSIONS
  Long-term survival after elective thoracic aortic surgery is excellent, with improved outcomes in the modern era. Several preoperative risk factors associated with decreased survival were identified, which could assist in risk stratification and patient selection. Finally, the long-term survival rates identified in the present study should serve as a benchmark to which new aortic interventions should be compared.
authors.affiliation: Division of Cardiovascular Surgery, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: jwille@interchange.ubc.ca.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Higgins
authors.affiliation: Providence Health Care Research Institute, Vancouver, British Columbia, Canada.
authors.forename: May K
authors.initials: MK
authors.lastname: Lee
authors.affiliation: Cardiac Services British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Caroll
authors.initials: C
authors.lastname: Co
authors.affiliation: Division of Cardiovascular Surgery, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Janusz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000601:surgery*; D019985:Benchmarking; D001955:British Columbia; D017558:Elective Surgical Procedures; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000401:mortality; D017741:Survivors; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality