Contemporary Results for Proximal Aortic Replacement in North America

• Type of Material: Article
• Authors: Judson B. Williams, Duke University; Eric D. Peterson, Duke University; Yue Zhao, Duke University; Sean M. O'Brien, Duke University; Nicholas D. Andersen, Duke University; D. Craig Miller, Stanford University; Edward Chen, Emory University; G. Chad Hughes, Duke University
• Language: English
• Date: 2012-09-25
• Publisher: Elsevier: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2012 American College of Cardiology Foundation.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jacc.2012.06.023
• Title of Journal or Parent Work: Journal of the American College of Cardiology
• ISSN: 0735-1097
• Volume: 60
• Issue: 13
• Start Page: 1156
• End Page: 1162
• Grant/Funding Information: Dr. Williams was supported in part by training grant T32-HL069749 from the National Institutes of Health and in part by grant U01-HL088953 from the National Institutes of Health Cardiothoracic Surgical Trials Network.
• Keywords: Aortic disease; Aortic surgery outcomes; Aortic aneurysm and dissection
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, General

Abstract

Objectives: The purpose of this study was to characterize operative outcomes for ascending aorta and arch replacement on a national scale and to develop risk models for mortality and major morbidity. Background: Contemporary outcomes for ascending aorta and arch replacement in North America are unknown. Methods: We queried the Society of Thoracic Surgeons Database for patients undergoing ascending aorta (with or without root) with or without arch replacement from 2004 to 2009. The database captured 45,894 cases, including 12,702 root, 22,048 supracoronary ascending alone, 6,786 ascending plus arch, and 4,358 root plus arch. Baseline characteristics and clinical outcomes were analyzed. A parsimonious multivariable logistic regression model was constructed to predict risks of mortality and major morbidity. Results: Operative mortality was 3.4% for elective cases and 15.4% for nonelective cases. A risk model for operative mortality (c-index 0.81) revealed a risk-adjusted odds ratio for death after emergent versus elective operation of 5.9 (95% confidence interval: 5.3 to 6.6). Among elective patients, end-stage renal disease and reoperative status were the strongest predictors of mortality (adjusted odds ratios: 4.0 [95% confidence interval: 2.6 to 6.4] and 2.3 (95% confidence interval: 1.9 to 2.7], respectively; p < 0.0001). Conclusions: Current outcomes for ascending aorta and arch replacement in North America are excellent for elective repair; however, results deteriorate for nonelective status, suggesting that increased screening and/or lowering thresholds for elective intervention could potentially improve outcomes. The predictive models presented may serve clinicians in counseling patients.