Now Available: Extensive Outcomes Data for Proximal Aortic Replacement

Patients contemplating elective replacement of the proximal aorta lack current information about the risks of the procedure. Now, investigators have used the Society of Thoracic Surgeons Database to study results of 45,894 ascending aortic and arch replacement surgeries performed during 2004–2009 and to identify predictors of adverse outcomes.

In the 27,202 patients who underwent an elective procedure, 30-day mortality was 3.4%. Independent predictors of mortality were preoperative dialysis, reoperation, concomitant coronary artery bypass grafting, moderate or severe chronic lung disease, New York Heart Association class IV heart failure, concomitant mitral valve procedure, female sex, immunosuppressive treatment, older age, and preoperative atrial fibrillation. Mortality was highest in patients undergoing replacement of both supracoronary ascending aorta and arch. Other adverse events were common: Stroke or coma occurred in 3.2%, renal failure in 4.4%, pneumonia in 4.1%, reoperation for bleeding in 5.7%, and prolonged ventilation in 16.2%. Almost one in 10 patients was hospitalized for more than 2 weeks after the operation.

Mortality was significantly higher in patients who underwent urgent or emergent surgery than in those who had elective surgery. The authors did not evaluate the variation in outcomes by site.