title: Risk model of cardiovascular surgery in 845 Marfan patients using the Japan adult cardiovascular surgery database.
abstract: The aim of this study was to evaluate the short-term operative results of patients with Marfan syndrome who underwent thoracic or abdominal aortic surgery in a 4-year period in Japan. Data were collected from the Japan Cardiovascular Surgery Database (JCVSD). We retrospectively analyzed the data of 845 patients with Marfan syndrome who underwent cardiovascular surgery between January 2008 and January 2011. Logistic regression was used to generate risk models. The early mortality rate was 4.4% (37/845). Odds ratios (OR), 95% confidence intervals (CI), and P values for structures and processes in the mortality prediction model were as follows: renal insufficiency (OR, 11.37; CI, 3.7234.66; P < 0.001); respiratory disorder (OR, 11.12; CI, 3.20-38.67; P < 0.001); aortic dissection (OR, 13.02; CI, 2.8060.60; P = 0.001); pseudoaneurysm (OR, 11.23; CI, 1.38-91.66; P = 0.024); thoracoabdominal aneurysm (OR, 2.67; CI, 1.22-5.84; P = 0.014); and aorticrupure (OR, 4.23; CI, 1.26-14.23; P = 0.002). The mortality prediction model had a Cindex of 0.82 and a Hosmer-Lemeshow P value of 0.56. In conclusion, this study demonstrated that renal insufficiency and respiratory disorder had great impact on the operative mortality of Marfan patients undergoing cardiovascular surgery. Because patients with aortic dissection or aortic rupture showed high operative mortality, close follow-up to avoid emergency operation is mandatory to improve the operative results. Achieving good results from surgery of the thoracoabdominal aorta was quite challenging, also in Marfan patients.
authors.affiliation: Department of Cardiovascular Surgery, St. Marianna University, School of Medicine.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Miyairi
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Miyata
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Taketani
authors.forename: Daigo
authors.initials: D
authors.lastname: Sawaki
authors.forename: Tohru
authors.initials: T
authors.lastname: Suzuki
authors.forename: Yasunobu
authors.initials: Y
authors.lastname: Hirata
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Shimizu
authors.forename: Noboru
authors.initials: N
authors.lastname: Motomura
authors.forename: Shinichi
authors.initials: S
authors.lastname: Takamoto
mesh_terms: D000328:Adult; D000784:Aortic Dissection / Q000209:etiology / Q000601:surgery*; D001014:Aortic Aneurysm / Q000209:etiology / Q000601:surgery*; D001018:Aortic Diseases / Q000209:etiology / Q000601:surgery*; D001019:Aortic Rupture / Q000209:etiology / Q000601:surgery; D013504:Cardiovascular Surgical Procedures / Q000401:mortality / Q000706:statistics & numerical data*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007564:Japan; D016015:Logistic Models; D008297:Male; D008382:Marfan Syndrome / Q000150:complications / Q000601:surgery*; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment