Thoracic Aorta False Aneurysm: What Surgical Strategy Should Be Recommended?

Mauricio A. Villavicencio, Thomas A. Orszulak, Thoralf M. Sundt, Richard C. Daly, Joseph A. Dearani, Christopher G A McGregor, Charles J. Mullany, Francisco J. Puga, Kenton J. Zehr, Hartzell V Schaff

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

Background: Thoracic aorta false aneurysms (TAFA) are a surgical challenge. The best technical approach remains uncertain. Methods: Between 1981 and 2004, 57 patients underwent operation for TAFA (mean age 57 ± 18 years; 43 [75%] were male). Symptoms included dyspnea 25 (44%), chest pain 22 (39%), and fever 18 (32%). Twelve (21%) were asymptomatic. Thirty-seven (65%) had undergone previous operation with a mean interval between operations of 80 ± 90 months. Fifteen (26%) had a mycotic etiology. The TAFA involved the aortic root in 10 (18%), ascending aorta in 28 (49%), arch in 6 (11%), and descending aorta in 13 (32%). Twenty-one (37%) required femorofemoral cannulation and 28 (49%), circulatory arrest. Surgical techniques included graft replacement in 27 (47%), composite root in 10 (18%), patch repair in 10 (18%), and direct suture in 10 (18%). Results: Operative mortality was 7% (4 patients). Four of 32 (13%) had massive hemorrhage during redo sternotomy, and all of these had planned extramediastinal cannulation (all survived). Follow-up was 100% for 349 patient-years. Actuarial survival was 77% ± 6%, 63% ± 8%, and freedom from recurrent TAFA was 87% ± 5% and 83% ± 7%, at 5 and 10 years, respectively. Univariate analysis identified TAFA greater than 55 mm, urgent operation, and NewYork Heart Association functional class III or IV as predictors of hemorrhage during redo sternotomy. Obesity and ejection fraction of 35% or less were predictors of operative death. Conclusions: Thoracic aorta false aneurysm symptoms may be minimal, and consequently a high degree of suspicion plus serial imaging is warranted. Extramediastinal cannulation, deep hypothermia, and circulatory arrest are required for large mediastinal TAFA. Despite serious risks, TAFA correction is possible with good long-term results.

Original languageEnglish (US)
Pages (from-to)81-89
Number of pages9
JournalAnnals of Thoracic Surgery
Volume82
Issue number1
DOIs
StatePublished - Jul 2006

Fingerprint

False Aneurysm
Thoracic Aorta
Catheterization
Sternotomy
Hemorrhage
Hypothermia
Chest Pain
Dyspnea
Sutures
Aorta
Fever
Obesity
Transplants
Survival
Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Villavicencio, M. A., Orszulak, T. A., Sundt, T. M., Daly, R. C., Dearani, J. A., McGregor, C. G. A., ... Schaff, H. V. (2006). Thoracic Aorta False Aneurysm: What Surgical Strategy Should Be Recommended? Annals of Thoracic Surgery, 82(1), 81-89. https://doi.org/10.1016/j.athoracsur.2006.02.081

Thoracic Aorta False Aneurysm : What Surgical Strategy Should Be Recommended? / Villavicencio, Mauricio A.; Orszulak, Thomas A.; Sundt, Thoralf M.; Daly, Richard C.; Dearani, Joseph A.; McGregor, Christopher G A; Mullany, Charles J.; Puga, Francisco J.; Zehr, Kenton J.; Schaff, Hartzell V.

In: Annals of Thoracic Surgery, Vol. 82, No. 1, 07.2006, p. 81-89.

Research output: Contribution to journalArticle

Villavicencio, MA, Orszulak, TA, Sundt, TM, Daly, RC, Dearani, JA, McGregor, CGA, Mullany, CJ, Puga, FJ, Zehr, KJ & Schaff, HV 2006, 'Thoracic Aorta False Aneurysm: What Surgical Strategy Should Be Recommended?', Annals of Thoracic Surgery, vol. 82, no. 1, pp. 81-89. https://doi.org/10.1016/j.athoracsur.2006.02.081
Villavicencio MA, Orszulak TA, Sundt TM, Daly RC, Dearani JA, McGregor CGA et al. Thoracic Aorta False Aneurysm: What Surgical Strategy Should Be Recommended? Annals of Thoracic Surgery. 2006 Jul;82(1):81-89. https://doi.org/10.1016/j.athoracsur.2006.02.081
Villavicencio, Mauricio A. ; Orszulak, Thomas A. ; Sundt, Thoralf M. ; Daly, Richard C. ; Dearani, Joseph A. ; McGregor, Christopher G A ; Mullany, Charles J. ; Puga, Francisco J. ; Zehr, Kenton J. ; Schaff, Hartzell V. / Thoracic Aorta False Aneurysm : What Surgical Strategy Should Be Recommended?. In: Annals of Thoracic Surgery. 2006 ; Vol. 82, No. 1. pp. 81-89.
@article{1f6a7e8bffd74762bb1fe61120f5ae54,
title = "Thoracic Aorta False Aneurysm: What Surgical Strategy Should Be Recommended?",
abstract = "Background: Thoracic aorta false aneurysms (TAFA) are a surgical challenge. The best technical approach remains uncertain. Methods: Between 1981 and 2004, 57 patients underwent operation for TAFA (mean age 57 ± 18 years; 43 [75{\%}] were male). Symptoms included dyspnea 25 (44{\%}), chest pain 22 (39{\%}), and fever 18 (32{\%}). Twelve (21{\%}) were asymptomatic. Thirty-seven (65{\%}) had undergone previous operation with a mean interval between operations of 80 ± 90 months. Fifteen (26{\%}) had a mycotic etiology. The TAFA involved the aortic root in 10 (18{\%}), ascending aorta in 28 (49{\%}), arch in 6 (11{\%}), and descending aorta in 13 (32{\%}). Twenty-one (37{\%}) required femorofemoral cannulation and 28 (49{\%}), circulatory arrest. Surgical techniques included graft replacement in 27 (47{\%}), composite root in 10 (18{\%}), patch repair in 10 (18{\%}), and direct suture in 10 (18{\%}). Results: Operative mortality was 7{\%} (4 patients). Four of 32 (13{\%}) had massive hemorrhage during redo sternotomy, and all of these had planned extramediastinal cannulation (all survived). Follow-up was 100{\%} for 349 patient-years. Actuarial survival was 77{\%} ± 6{\%}, 63{\%} ± 8{\%}, and freedom from recurrent TAFA was 87{\%} ± 5{\%} and 83{\%} ± 7{\%}, at 5 and 10 years, respectively. Univariate analysis identified TAFA greater than 55 mm, urgent operation, and NewYork Heart Association functional class III or IV as predictors of hemorrhage during redo sternotomy. Obesity and ejection fraction of 35{\%} or less were predictors of operative death. Conclusions: Thoracic aorta false aneurysm symptoms may be minimal, and consequently a high degree of suspicion plus serial imaging is warranted. Extramediastinal cannulation, deep hypothermia, and circulatory arrest are required for large mediastinal TAFA. Despite serious risks, TAFA correction is possible with good long-term results.",
author = "Villavicencio, {Mauricio A.} and Orszulak, {Thomas A.} and Sundt, {Thoralf M.} and Daly, {Richard C.} and Dearani, {Joseph A.} and McGregor, {Christopher G A} and Mullany, {Charles J.} and Puga, {Francisco J.} and Zehr, {Kenton J.} and Schaff, {Hartzell V}",
year = "2006",
month = "7",
doi = "10.1016/j.athoracsur.2006.02.081",
language = "English (US)",
volume = "82",
pages = "81--89",
journal = "Annals of Thoracic Surgery",
issn = "0003-4975",
publisher = "Elsevier USA",
number = "1",

}

TY - JOUR

T1 - Thoracic Aorta False Aneurysm

T2 - What Surgical Strategy Should Be Recommended?

AU - Villavicencio, Mauricio A.

AU - Orszulak, Thomas A.

AU - Sundt, Thoralf M.

AU - Daly, Richard C.

AU - Dearani, Joseph A.

AU - McGregor, Christopher G A

AU - Mullany, Charles J.

AU - Puga, Francisco J.

AU - Zehr, Kenton J.

AU - Schaff, Hartzell V

PY - 2006/7

Y1 - 2006/7

N2 - Background: Thoracic aorta false aneurysms (TAFA) are a surgical challenge. The best technical approach remains uncertain. Methods: Between 1981 and 2004, 57 patients underwent operation for TAFA (mean age 57 ± 18 years; 43 [75%] were male). Symptoms included dyspnea 25 (44%), chest pain 22 (39%), and fever 18 (32%). Twelve (21%) were asymptomatic. Thirty-seven (65%) had undergone previous operation with a mean interval between operations of 80 ± 90 months. Fifteen (26%) had a mycotic etiology. The TAFA involved the aortic root in 10 (18%), ascending aorta in 28 (49%), arch in 6 (11%), and descending aorta in 13 (32%). Twenty-one (37%) required femorofemoral cannulation and 28 (49%), circulatory arrest. Surgical techniques included graft replacement in 27 (47%), composite root in 10 (18%), patch repair in 10 (18%), and direct suture in 10 (18%). Results: Operative mortality was 7% (4 patients). Four of 32 (13%) had massive hemorrhage during redo sternotomy, and all of these had planned extramediastinal cannulation (all survived). Follow-up was 100% for 349 patient-years. Actuarial survival was 77% ± 6%, 63% ± 8%, and freedom from recurrent TAFA was 87% ± 5% and 83% ± 7%, at 5 and 10 years, respectively. Univariate analysis identified TAFA greater than 55 mm, urgent operation, and NewYork Heart Association functional class III or IV as predictors of hemorrhage during redo sternotomy. Obesity and ejection fraction of 35% or less were predictors of operative death. Conclusions: Thoracic aorta false aneurysm symptoms may be minimal, and consequently a high degree of suspicion plus serial imaging is warranted. Extramediastinal cannulation, deep hypothermia, and circulatory arrest are required for large mediastinal TAFA. Despite serious risks, TAFA correction is possible with good long-term results.

AB - Background: Thoracic aorta false aneurysms (TAFA) are a surgical challenge. The best technical approach remains uncertain. Methods: Between 1981 and 2004, 57 patients underwent operation for TAFA (mean age 57 ± 18 years; 43 [75%] were male). Symptoms included dyspnea 25 (44%), chest pain 22 (39%), and fever 18 (32%). Twelve (21%) were asymptomatic. Thirty-seven (65%) had undergone previous operation with a mean interval between operations of 80 ± 90 months. Fifteen (26%) had a mycotic etiology. The TAFA involved the aortic root in 10 (18%), ascending aorta in 28 (49%), arch in 6 (11%), and descending aorta in 13 (32%). Twenty-one (37%) required femorofemoral cannulation and 28 (49%), circulatory arrest. Surgical techniques included graft replacement in 27 (47%), composite root in 10 (18%), patch repair in 10 (18%), and direct suture in 10 (18%). Results: Operative mortality was 7% (4 patients). Four of 32 (13%) had massive hemorrhage during redo sternotomy, and all of these had planned extramediastinal cannulation (all survived). Follow-up was 100% for 349 patient-years. Actuarial survival was 77% ± 6%, 63% ± 8%, and freedom from recurrent TAFA was 87% ± 5% and 83% ± 7%, at 5 and 10 years, respectively. Univariate analysis identified TAFA greater than 55 mm, urgent operation, and NewYork Heart Association functional class III or IV as predictors of hemorrhage during redo sternotomy. Obesity and ejection fraction of 35% or less were predictors of operative death. Conclusions: Thoracic aorta false aneurysm symptoms may be minimal, and consequently a high degree of suspicion plus serial imaging is warranted. Extramediastinal cannulation, deep hypothermia, and circulatory arrest are required for large mediastinal TAFA. Despite serious risks, TAFA correction is possible with good long-term results.

UR - http://www.scopus.com/inward/record.url?scp=33745200266&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33745200266&partnerID=8YFLogxK

U2 - 10.1016/j.athoracsur.2006.02.081

DO - 10.1016/j.athoracsur.2006.02.081

M3 - Article

C2 - 16798195

AN - SCOPUS:33745200266

VL - 82

SP - 81

EP - 89

JO - Annals of Thoracic Surgery

JF - Annals of Thoracic Surgery

SN - 0003-4975

IS - 1

ER -