Abstract

Objective: This retrospective study evaluates, if recent refinements in peri-operative management, have an impact on clinical outcome of patients undergoing elective repair of their ascending thoracic aorta. Methods: One hundred sixty five (n=165) consecutive patients were operated during a 7 year period at our department. The cohort was divided in an early group I (from Jan 1997 to Dec 1999, n=75) and a late group II (from Jan 2000 to Jan 2003, n=90). The mean age was 60.9±13.1 years in group I versus 58.1±13.6 years in group II. In group I 50 patients (66.6%) underwent replacement of the ascending thoracic aorta alone, 17 patients (22.6%) received a composite graft, 8 patients (10.6%) had an additional aortic valve replacement and 14 patients (18.6%) needed concomitant coronary artery bypass grafting. In group II the procedures were as follows: interposition graft alone in 58 patients (64.4%), composite graft in 26 patients (28.8%), aortic valve replacement in 6 (6.6%) and CABG in 11 patients (12.2%). Results: Overall hospital mortality for the entire cohort was 6.6% (11/165) with no significant differences between the early and late group with 6.6% (5/75) and 6.6% (6/90), respectively, P=0.985. Causes were multi organ failure in 63.3% (n=7), stroke in 9% (n=1), myocardial infarction in 18.1% (n=2) and refractory bleeding in 9% (n=1). Concomitant CABG, repair of the aortic valve and composite graft, emerged as independent risk factor for mortality in multivariate logistic regression analysis with P=0.001. Differences, became apparent in ICU as well as hospital stay with a median ICU stay in group I of 7.1±12.9 days versus 4.4±6.8 days in group II, and median hospital stay of 16.7±5.3 days versus 9.5±8.4 days for group I and II, P<0.05, respectively. Furthermore through the implementation of blood conservation techniques, a substantial reduction of transfusion requirements could be achieved (PRBC from 3.2±4 to 1.1±1.7 units, FFP 5.2±3 to 2.3±0.5 units, Platelets from 1.3±2 to 0.3±0.07 units). Conclusions: Even with the implementation of various refinements in surgical and anaesthetic techniques, the current risk of mortality for ascending aortic aneurysm repair has not changed in the last 7 years However, shortened ICU and hospital stays as well as diminished usage of blood derivates are mainly the result of a more aggressive and improved peri- and post-operative management due to economic considerations.

Author Keywords: Ascending thoracic aorta; Surgical repair; ICU stay; Hospital stay; Peri-operative management

Article Outline

1. Introduction

2. Material and methods

2.1. Patient cohort

2.2. Surgical considerations

2.3. Anaesthetic and perfusion management

2.4. Blood conservation methods

2.5. Statistical analysis

3. Results

3.1. Intra operative details

3.2. Blood product usage

3.3. ICU and hospital stay

3.4. Complications and early mortality

4. Discussion

References