Influence of aortitis on late outcomes after repair of ascending aortic aneurysms Read at the American Association for Thoracic Surgery Aortic Symposium, New York, New York, April 24-25, 2014.

Hirokazu Fujimoto, Meghana R K Helder, Alberto Pochettino, Kevin L. Greason, Rakesh M. Suri, Richard C. Daly, Joseph A. Dearani, Joseph Maleszewski, Zhuo Li, Hartzell V Schaff

Research output: Contribution to journalArticle

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Abstract

Objective To determine outcomes of repair of ascending aortic aneurysms in patients with histopathologic diagnoses of aortitis. Methods We reviewed histopathologic findings and outcomes of elective repair of ascending aortic aneurysms between January 1, 1955, and December 31, 2012. Noninfectious aortitis was identified in 186 patients, and we compared outcomes for these patients with outcomes for others operated on at the same time with diagnoses of medial degeneration (n = 317) or atherosclerosis (n = 232). Results Early mortality (<30 days postoperatively) for patients with aortitis was 2%, and overall 10-year survival was 45%, compared with 66% for patients with medial degeneration, and 45% for patients with atherosclerosis (P <.001 vs medial degeneration). In addition to histopathologic diagnosis, overall mortality was influenced by older age at operation (hazard ratio [HR]: 1.060; 95% confidence interval [CI], 1.046-1.077; P <.001), chronic obstructive pulmonary disease (HR: 1.560; 95% CI: 1.136-2.136; P =.006); concomitant coronary artery bypass grafting (HR: 1.980; 95% CI: 1.520-2.600; P <.001); and use of circulatory arrest (HR: 1.500; 95% CI: 1.148-1.960; P =.003). Risk of aortic reoperation at 10 years was 21% for aortitis patients, compared with 11% for those with medial degeneration, and 19% for patients with atherosclerosis (P =.028). Conclusions Patients with repaired ascending aneurysms secondary to noninfectious aortitis have low early mortality, but late risks of death and aortic reoperation are increased, compared with these outcomes for patients with aneurysms that result from medial degeneration.

Original languageEnglish (US)
Pages (from-to)589-594
Number of pages6
JournalJournal of Thoracic and Cardiovascular Surgery
Volume150
Issue number3
DOIs
StatePublished - Sep 1 2015

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Aortitis
Aortic Aneurysm
Confidence Intervals
Atherosclerosis
Reoperation
Aneurysm
Mortality
Coronary Artery Bypass
Chronic Obstructive Pulmonary Disease

Keywords

  • aortic aneurysm
  • aortic repair
  • aortitis

ASJC Scopus subject areas

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

Cite this

Influence of aortitis on late outcomes after repair of ascending aortic aneurysms Read at the American Association for Thoracic Surgery Aortic Symposium, New York, New York, April 24-25, 2014. / Fujimoto, Hirokazu; Helder, Meghana R K; Pochettino, Alberto; Greason, Kevin L.; Suri, Rakesh M.; Daly, Richard C.; Dearani, Joseph A.; Maleszewski, Joseph; Li, Zhuo; Schaff, Hartzell V.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 150, No. 3, 01.09.2015, p. 589-594.

Research output: Contribution to journalArticle

Fujimoto, Hirokazu ; Helder, Meghana R K ; Pochettino, Alberto ; Greason, Kevin L. ; Suri, Rakesh M. ; Daly, Richard C. ; Dearani, Joseph A. ; Maleszewski, Joseph ; Li, Zhuo ; Schaff, Hartzell V. / Influence of aortitis on late outcomes after repair of ascending aortic aneurysms Read at the American Association for Thoracic Surgery Aortic Symposium, New York, New York, April 24-25, 2014. In: Journal of Thoracic and Cardiovascular Surgery. 2015 ; Vol. 150, No. 3. pp. 589-594.
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abstract = "Objective To determine outcomes of repair of ascending aortic aneurysms in patients with histopathologic diagnoses of aortitis. Methods We reviewed histopathologic findings and outcomes of elective repair of ascending aortic aneurysms between January 1, 1955, and December 31, 2012. Noninfectious aortitis was identified in 186 patients, and we compared outcomes for these patients with outcomes for others operated on at the same time with diagnoses of medial degeneration (n = 317) or atherosclerosis (n = 232). Results Early mortality (<30 days postoperatively) for patients with aortitis was 2{\%}, and overall 10-year survival was 45{\%}, compared with 66{\%} for patients with medial degeneration, and 45{\%} for patients with atherosclerosis (P <.001 vs medial degeneration). In addition to histopathologic diagnosis, overall mortality was influenced by older age at operation (hazard ratio [HR]: 1.060; 95{\%} confidence interval [CI], 1.046-1.077; P <.001), chronic obstructive pulmonary disease (HR: 1.560; 95{\%} CI: 1.136-2.136; P =.006); concomitant coronary artery bypass grafting (HR: 1.980; 95{\%} CI: 1.520-2.600; P <.001); and use of circulatory arrest (HR: 1.500; 95{\%} CI: 1.148-1.960; P =.003). Risk of aortic reoperation at 10 years was 21{\%} for aortitis patients, compared with 11{\%} for those with medial degeneration, and 19{\%} for patients with atherosclerosis (P =.028). Conclusions Patients with repaired ascending aneurysms secondary to noninfectious aortitis have low early mortality, but late risks of death and aortic reoperation are increased, compared with these outcomes for patients with aneurysms that result from medial degeneration.",
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AU - Fujimoto, Hirokazu

AU - Helder, Meghana R K

AU - Pochettino, Alberto

AU - Greason, Kevin L.

AU - Suri, Rakesh M.

AU - Daly, Richard C.

AU - Dearani, Joseph A.

AU - Maleszewski, Joseph

AU - Li, Zhuo

AU - Schaff, Hartzell V

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N2 - Objective To determine outcomes of repair of ascending aortic aneurysms in patients with histopathologic diagnoses of aortitis. Methods We reviewed histopathologic findings and outcomes of elective repair of ascending aortic aneurysms between January 1, 1955, and December 31, 2012. Noninfectious aortitis was identified in 186 patients, and we compared outcomes for these patients with outcomes for others operated on at the same time with diagnoses of medial degeneration (n = 317) or atherosclerosis (n = 232). Results Early mortality (<30 days postoperatively) for patients with aortitis was 2%, and overall 10-year survival was 45%, compared with 66% for patients with medial degeneration, and 45% for patients with atherosclerosis (P <.001 vs medial degeneration). In addition to histopathologic diagnosis, overall mortality was influenced by older age at operation (hazard ratio [HR]: 1.060; 95% confidence interval [CI], 1.046-1.077; P <.001), chronic obstructive pulmonary disease (HR: 1.560; 95% CI: 1.136-2.136; P =.006); concomitant coronary artery bypass grafting (HR: 1.980; 95% CI: 1.520-2.600; P <.001); and use of circulatory arrest (HR: 1.500; 95% CI: 1.148-1.960; P =.003). Risk of aortic reoperation at 10 years was 21% for aortitis patients, compared with 11% for those with medial degeneration, and 19% for patients with atherosclerosis (P =.028). Conclusions Patients with repaired ascending aneurysms secondary to noninfectious aortitis have low early mortality, but late risks of death and aortic reoperation are increased, compared with these outcomes for patients with aneurysms that result from medial degeneration.

AB - Objective To determine outcomes of repair of ascending aortic aneurysms in patients with histopathologic diagnoses of aortitis. Methods We reviewed histopathologic findings and outcomes of elective repair of ascending aortic aneurysms between January 1, 1955, and December 31, 2012. Noninfectious aortitis was identified in 186 patients, and we compared outcomes for these patients with outcomes for others operated on at the same time with diagnoses of medial degeneration (n = 317) or atherosclerosis (n = 232). Results Early mortality (<30 days postoperatively) for patients with aortitis was 2%, and overall 10-year survival was 45%, compared with 66% for patients with medial degeneration, and 45% for patients with atherosclerosis (P <.001 vs medial degeneration). In addition to histopathologic diagnosis, overall mortality was influenced by older age at operation (hazard ratio [HR]: 1.060; 95% confidence interval [CI], 1.046-1.077; P <.001), chronic obstructive pulmonary disease (HR: 1.560; 95% CI: 1.136-2.136; P =.006); concomitant coronary artery bypass grafting (HR: 1.980; 95% CI: 1.520-2.600; P <.001); and use of circulatory arrest (HR: 1.500; 95% CI: 1.148-1.960; P =.003). Risk of aortic reoperation at 10 years was 21% for aortitis patients, compared with 11% for those with medial degeneration, and 19% for patients with atherosclerosis (P =.028). Conclusions Patients with repaired ascending aneurysms secondary to noninfectious aortitis have low early mortality, but late risks of death and aortic reoperation are increased, compared with these outcomes for patients with aneurysms that result from medial degeneration.

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