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Impact of pre-existing conditions, age and the length of cardiopulmonary bypass on postoperative outcome after repair of the ascending aorta and aortic arch for aortic aneurysms and dissections

^a Department of Thoracic and Cardiovascular Surgery, Loyola University Chicago, Stritch School of Medicine, 2160 South First Ave., Building 110, Room 6243, Maywood, IL 60153, USA
^b Department of Surgery, St Vincent Medical Center, New York Medical College, School of Medicine, 170 West 12th Street, New York City, NY 10011, USA

*Corresponding author. Tel.: +1 617 9352782.

E-mail address: Sneragi{at}yahoo.com (S. Neragi-Miandoab).

Background: Repair of the ascending aorta and aortic arch carries a high morbidity and mortality, which can be complicated by the often emergent nature of the intervention. Methods: We retrospectively evaluated the morbidity, mortality, and long-term survival in 101 patients who underwent repair of ascending aorta and aortic arch. Depending on the urgency of the operation, the patients were categorized as elective (EL, n=82) or emergent (EM, n=19). Log-rank-list and SPS were used to evaluate the data. Results: The average age was 58±16 years. The aortic diameter was 5.5±1 cm in the EL group and 6.1±1.4 cm for EM group. The aortic dissection in EL and EM groups was 15% and 79%, respectively. The mean circulatory arrest time (n=32 patients) was 38±18.5 min. The overall 30-day mortality was 4%: 0% for the EL group and 26% for the EM group. The overall 6-month mortality was 8%: 3.7% and 26% in EL and EM groups, respectively. Overall CVA was 3%: 0% in the EL group and 15.7% in the EM group. The mean CPB time was 176±81 min. The prolonged CPB time correlated with increased need for blood transfusion. The LOS was 12±8 days and correlated with increasing age (95% CI 0.06860–0.2307, P=0.0004), with NYHA stage of patients at the time of surgery (95% confidence intervals, 1.328–4.202, P=0.0003), with left ventricular ejection fraction (95% CI 0.2357 to –0.003029, P=0.0442) and with postoperative atrial fibrillation (95% CI 0.1192–0.4745, P=0.0018). The average ICU stay was 123±145 h. A prolonged CPB time resulted in extended ICU stay (95% CI 0.3655–1.486, P=0.0014). Further, the length of ICU stay correlated with NYHA status (95% CI 19.98–73.42, P=0.0008), age (95% confidence intervals 0.01668–3.761, P=0.0477), urgency of surgery (95% CI 65.00–124.0, P<0.0001), and length of CPB time (95% CI 0.3655–1.486, P=0.0014). Conclusion: Emergent operations are associated with high morbidity and mortality. Pre-existing heart failure, advanced age, and prolonged cardiopulmonary bypass are associated with prolonged monitoring in the ICU.

Key Words: Aortic dissection; Ascending aorta; Aortic arch; Aortic aneurysm