Long-term results after proximal thoracic aortic redo surgery

Czerny, Martin; Barchichat, Ilan; Meszaros, Katharina; Sodeck, Gottfried H; Weber, Alberto; Reineke, David Christian; Englberger, Lars; Schönhoff, Florian; Kadner, Alexander; Jenni, Hansjörg; Schmidli, Jürg; Carrel, Thierry (2013). Long-term results after proximal thoracic aortic redo surgery. PLoS ONE, 8(3), e57713. Lawrence, Kans.: Public Library of Science 10.1371/journal.pone.0057713

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Objective: To evaluate early and mid-term results in patients undergoing proximal thoracic aortic redo surgery.

Methods: We analyzed 60 patients (median age 60 years, median logistic EuroSCORE 40) who underwent proximal thoracic aortic redo surgery between January 2005 and April 2012. Outcome and risk factors were analyzed.

Results: In hospital mortality was 13%, perioperative neurologic injury was 7%. Fifty percent of patients underwent redo surgery in an urgent or emergency setting. In 65%, partial or total arch replacement with or without conventional or frozen elephant trunk extension was performed. The preoperative logistic EuroSCORE I confirmed to be a reliable predictor of adverse outcome- (ROC 0.786, 95%CI 0.64–0.93) as did the new EuroSCORE II model: ROC 0.882 95%CI 0.78–0.98. Extensive individual logistic EuroSCORE I levels more than 67 showed an OR of 7.01, 95%CI 1.43–34.27. A EuroSCORE II larger than 28 showed an OR of 4.44 (95%CI 1.4–14.06). Multivariate logistic regression analysis identified a critical preoperative state (OR 7.96, 95%CI 1.51–38.79) but not advanced age (OR 2.46, 95%CI 0.48–12.66) as the strongest independent predictor of in-hospital mortality. Median follow-up was 23 months (1–52 months). One year and five year actuarial survival rates were 83% and 69% respectively. Freedom from reoperation during follow-up was 100%.

Conclusions: Despite a substantial early attrition rate in patients presenting with a critical preoperative state, proximal thoracic aortic redo surgery provides excellent early and mid-term results. Higher EuroSCORE I and II levels and a critical preoperative state but not advanced age are independent predictors of in-hospital mortality. As a consequence, age alone should no longer be regarded as a contraindication for surgical treatment in this particular group of patient

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiovascular Surgery

UniBE Contributor:

Czerny, Martin; Weber, Alberto; Reineke, David Christian; Englberger, Lars; Schönhoff, Florian; Kadner, Alexander; Jenni, Hansjoerg; Schmidli, Jürg and Carrel, Thierry

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1932-6203

Publisher:

Public Library of Science

Language:

English

Submitter:

Factscience Import

Date Deposited:

04 Oct 2013 14:37

Last Modified:

14 Dec 2014 10:43

Publisher DOI:

10.1371/journal.pone.0057713

PubMed ID:

23469220

Web of Science ID:

000315897100031

BORIS DOI:

10.7892/boris.14750

URI:

https://boris.unibe.ch/id/eprint/14750 (FactScience: 221861)

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