Impact of Medical Therapy on Late Morbidity and Mortality After Aortic Aneurysm Repair for Aortitis

Anjali Prasad, Meghana R.K. Helder, Brian D. Lahr, Joseph A. Dearani, Kevin L. Greason, Alberto Pochettino, Kenneth J Warrington, Heidi M. Connolly, Nandan S. Anavekar, Hartzell V Schaff

Research output: Contribution to journalArticle

Abstract

Background: Patients with active aortitis who undergo repair of ascending aortic aneurysms have an increased risk of late reoperation and decreased late survival. We aimed to determine the reasons for these poor outcomes and the influence of medical management. Methods: We reviewed records of 186 patients (median age 73.9 years; 120 women) with noninfectious aortitis after elective ascending aortic aneurysm repair (January 1955 through December 2012). Landmark analysis was used to compare outcomes in patients with isolated aortitis versus with systemic sequelae of aortitis along with outcomes of treatment with glucocorticoids. Results: At 15 years, the overall mortality was 88.3%; at 10 years, the overall reoperation rate was 28.2%. Long-term mortality increased with older age at surgery (hazard ratio [HR] 1.62, 95% confidence interval [CI]: 1.25 to 2.11, p < 0.001), coronary artery disease (HR 1.94, 95% CI: 1.25 to 3.01, p = 0.003), peripheral vascular disease (HR 1.79, 95% CI: 1.09 to 2.94, p = 0.02), and preoperative suspicion of aortitis (HR 4.90, 95% CI: 1.96 to 12.26, p < 0.001). Increased reoperation rate was associated with coronary artery disease (HR 2.69, 95% CI: 1.17 to 6.17, p = 0.02) and peripheral vascular disease (HR 3.92, 95% CI: 1.71 to 8.94, p = 0.001). Among patients free of reoperation at 6 months, systemic sequelae of aortitis were found to be significant, with an unadjusted hazard ratio of 3.59 (95% CI: 1.40 to 9.18, p = 0.008). Treatment with glucocorticoids was not associated with subsequent mortality or reoperation. Conclusions: The development of systemic illness secondary to aortitis was associated with increased risk of late aortic reoperations. However, glucocorticoid treatment of noninfectious aortitis did not clearly influence survival or need for reoperation.

Original languageEnglish (US)
Pages (from-to)1731-1736
Number of pages6
JournalAnnals of Thoracic Surgery
Volume105
Issue number6
DOIs
StatePublished - Jun 1 2018

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Aortitis
Aortic Aneurysm
Reoperation
Morbidity
Confidence Intervals
Mortality
Glucocorticoids
Peripheral Vascular Diseases
Therapeutics
Coronary Artery Disease
Survival

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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Impact of Medical Therapy on Late Morbidity and Mortality After Aortic Aneurysm Repair for Aortitis. / Prasad, Anjali; Helder, Meghana R.K.; Lahr, Brian D.; Dearani, Joseph A.; Greason, Kevin L.; Pochettino, Alberto; Warrington, Kenneth J; Connolly, Heidi M.; Anavekar, Nandan S.; Schaff, Hartzell V.

In: Annals of Thoracic Surgery, Vol. 105, No. 6, 01.06.2018, p. 1731-1736.

Research output: Contribution to journalArticle

Prasad, A, Helder, MRK, Lahr, BD, Dearani, JA, Greason, KL, Pochettino, A, Warrington, KJ, Connolly, HM, Anavekar, NS & Schaff, HV 2018, 'Impact of Medical Therapy on Late Morbidity and Mortality After Aortic Aneurysm Repair for Aortitis', Annals of Thoracic Surgery, vol. 105, no. 6, pp. 1731-1736. https://doi.org/10.1016/j.athoracsur.2018.01.009
Prasad, Anjali ; Helder, Meghana R.K. ; Lahr, Brian D. ; Dearani, Joseph A. ; Greason, Kevin L. ; Pochettino, Alberto ; Warrington, Kenneth J ; Connolly, Heidi M. ; Anavekar, Nandan S. ; Schaff, Hartzell V. / Impact of Medical Therapy on Late Morbidity and Mortality After Aortic Aneurysm Repair for Aortitis. In: Annals of Thoracic Surgery. 2018 ; Vol. 105, No. 6. pp. 1731-1736.
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abstract = "Background: Patients with active aortitis who undergo repair of ascending aortic aneurysms have an increased risk of late reoperation and decreased late survival. We aimed to determine the reasons for these poor outcomes and the influence of medical management. Methods: We reviewed records of 186 patients (median age 73.9 years; 120 women) with noninfectious aortitis after elective ascending aortic aneurysm repair (January 1955 through December 2012). Landmark analysis was used to compare outcomes in patients with isolated aortitis versus with systemic sequelae of aortitis along with outcomes of treatment with glucocorticoids. Results: At 15 years, the overall mortality was 88.3{\%}; at 10 years, the overall reoperation rate was 28.2{\%}. Long-term mortality increased with older age at surgery (hazard ratio [HR] 1.62, 95{\%} confidence interval [CI]: 1.25 to 2.11, p < 0.001), coronary artery disease (HR 1.94, 95{\%} CI: 1.25 to 3.01, p = 0.003), peripheral vascular disease (HR 1.79, 95{\%} CI: 1.09 to 2.94, p = 0.02), and preoperative suspicion of aortitis (HR 4.90, 95{\%} CI: 1.96 to 12.26, p < 0.001). Increased reoperation rate was associated with coronary artery disease (HR 2.69, 95{\%} CI: 1.17 to 6.17, p = 0.02) and peripheral vascular disease (HR 3.92, 95{\%} CI: 1.71 to 8.94, p = 0.001). Among patients free of reoperation at 6 months, systemic sequelae of aortitis were found to be significant, with an unadjusted hazard ratio of 3.59 (95{\%} CI: 1.40 to 9.18, p = 0.008). Treatment with glucocorticoids was not associated with subsequent mortality or reoperation. Conclusions: The development of systemic illness secondary to aortitis was associated with increased risk of late aortic reoperations. However, glucocorticoid treatment of noninfectious aortitis did not clearly influence survival or need for reoperation.",
author = "Anjali Prasad and Helder, {Meghana R.K.} and Lahr, {Brian D.} and Dearani, {Joseph A.} and Greason, {Kevin L.} and Alberto Pochettino and Warrington, {Kenneth J} and Connolly, {Heidi M.} and Anavekar, {Nandan S.} and Schaff, {Hartzell V}",
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AU - Prasad, Anjali

AU - Helder, Meghana R.K.

AU - Lahr, Brian D.

AU - Dearani, Joseph A.

AU - Greason, Kevin L.

AU - Pochettino, Alberto

AU - Warrington, Kenneth J

AU - Connolly, Heidi M.

AU - Anavekar, Nandan S.

AU - Schaff, Hartzell V

PY - 2018/6/1

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N2 - Background: Patients with active aortitis who undergo repair of ascending aortic aneurysms have an increased risk of late reoperation and decreased late survival. We aimed to determine the reasons for these poor outcomes and the influence of medical management. Methods: We reviewed records of 186 patients (median age 73.9 years; 120 women) with noninfectious aortitis after elective ascending aortic aneurysm repair (January 1955 through December 2012). Landmark analysis was used to compare outcomes in patients with isolated aortitis versus with systemic sequelae of aortitis along with outcomes of treatment with glucocorticoids. Results: At 15 years, the overall mortality was 88.3%; at 10 years, the overall reoperation rate was 28.2%. Long-term mortality increased with older age at surgery (hazard ratio [HR] 1.62, 95% confidence interval [CI]: 1.25 to 2.11, p < 0.001), coronary artery disease (HR 1.94, 95% CI: 1.25 to 3.01, p = 0.003), peripheral vascular disease (HR 1.79, 95% CI: 1.09 to 2.94, p = 0.02), and preoperative suspicion of aortitis (HR 4.90, 95% CI: 1.96 to 12.26, p < 0.001). Increased reoperation rate was associated with coronary artery disease (HR 2.69, 95% CI: 1.17 to 6.17, p = 0.02) and peripheral vascular disease (HR 3.92, 95% CI: 1.71 to 8.94, p = 0.001). Among patients free of reoperation at 6 months, systemic sequelae of aortitis were found to be significant, with an unadjusted hazard ratio of 3.59 (95% CI: 1.40 to 9.18, p = 0.008). Treatment with glucocorticoids was not associated with subsequent mortality or reoperation. Conclusions: The development of systemic illness secondary to aortitis was associated with increased risk of late aortic reoperations. However, glucocorticoid treatment of noninfectious aortitis did not clearly influence survival or need for reoperation.

AB - Background: Patients with active aortitis who undergo repair of ascending aortic aneurysms have an increased risk of late reoperation and decreased late survival. We aimed to determine the reasons for these poor outcomes and the influence of medical management. Methods: We reviewed records of 186 patients (median age 73.9 years; 120 women) with noninfectious aortitis after elective ascending aortic aneurysm repair (January 1955 through December 2012). Landmark analysis was used to compare outcomes in patients with isolated aortitis versus with systemic sequelae of aortitis along with outcomes of treatment with glucocorticoids. Results: At 15 years, the overall mortality was 88.3%; at 10 years, the overall reoperation rate was 28.2%. Long-term mortality increased with older age at surgery (hazard ratio [HR] 1.62, 95% confidence interval [CI]: 1.25 to 2.11, p < 0.001), coronary artery disease (HR 1.94, 95% CI: 1.25 to 3.01, p = 0.003), peripheral vascular disease (HR 1.79, 95% CI: 1.09 to 2.94, p = 0.02), and preoperative suspicion of aortitis (HR 4.90, 95% CI: 1.96 to 12.26, p < 0.001). Increased reoperation rate was associated with coronary artery disease (HR 2.69, 95% CI: 1.17 to 6.17, p = 0.02) and peripheral vascular disease (HR 3.92, 95% CI: 1.71 to 8.94, p = 0.001). Among patients free of reoperation at 6 months, systemic sequelae of aortitis were found to be significant, with an unadjusted hazard ratio of 3.59 (95% CI: 1.40 to 9.18, p = 0.008). Treatment with glucocorticoids was not associated with subsequent mortality or reoperation. Conclusions: The development of systemic illness secondary to aortitis was associated with increased risk of late aortic reoperations. However, glucocorticoid treatment of noninfectious aortitis did not clearly influence survival or need for reoperation.

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