Early and late outcomes after open ascending aortic surgery: 47-year experience in a single centre

Abstract

The aims of the study are to describe the long-term survival of patients undergoing primary open ascending aortic surgery and to portray the evolution of aortic surgery during six decades in a single centre. Included were all 614 patients who underwent primary ascending aortic surgery in 1968–2014 at one Nordic university hospital. Patients were identified and data were collected from patient records and surgical logs. Mortality data were acquired from the national registry. Median follow-up was 11.2 years using reverse Kaplan–Meier method. Overall 30-day survival was 91.2% and for 30-day survivor rates were 86.9, 77.6, 52.1, 38.3 and 26.7% at 5, 10, 20, 30 and 40 years. There was no significant difference in long-term survival for 30-day survivors (p = 0.105) between patients treated emergently for dissection/rupture and electively (mainly ascending aortic aneurysms). On Cox regression era of surgery (p = 0.006), increasing age (p < 0.001) and indication (p < 0.001) were predictors of 30-day mortality. Arch involvement indicated twofold risk (HR 2.09, p = 0.05) compared to non-arch involved. Only increasing age (p < 0.001) predicted long-term mortality. There was a sixfold risk of 30-day mortality in the earliest era compared to the latest (p = 0.03). After the early postoperative phase following ascending aortic surgery, the surgical indication and urgency of the index operation have no significant impact on long-term survival. The very long term survival after ascending aortic surgery is excellent for 30-day survivors and improved through the era. Surgical treatment has improved and perioperative mortality has decreased significantly in 47 years.

Acute type A aortic dissection – a review

“…The existing literature often implicates the aforementioned non-surgical characteristics as prognostic factors for late mortality, but on the other hand age and the comorbidity burden of the patients (mainly atherosclerosis) is also important for longterm survival in contemporary single-centre and multicentre series. Long-term postoperative survival after ATAAD repair is satisfactory and has improved in recent years: 84-85% at 5 years [9,62,109,110], 64-68% at 10 years [31,109,111,8], and up to 38% at 30 years [110].…”

Life Expectancy after Surgery for Ascending Aortic Aneurysm

“…Moreover, some studies [6,8,[11][12][13] have described the long-term survival of patients undergoing ascending aortic surgery. But these results, without comparing them with the general population of the same territory, provide little information since the life expectancy of any group depends on a collection of environmental and socio-economic factors of the territory where they reside.…”

Association between institutional case volume and mortality following thoracic aorta replacement: a nationwide Korean cohort study

“…Third, the information on the severity of thoracic aorta disease was lacking and may have affected postoperative patient outcome. Although a study suggested that the surgical indication for aorta surgery (dissection/ruptured aneurysm vs. intact aneurysms) had little effect on longterm mortality for 30-day survivors [28], another study suggested that in-hospital mortality seems to be worse in patients with ruptured thoracic aortic aneurysms compared to patients with intact thoracic aortic aneurysms [29]. Fourth, individual surgeon volume was not analyzed.…”