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Eur J Cardiothorac Surg 2004;26:342-347
© 2004 Elsevier Science NL
a Department of Cardiothoracic Surgery, Medical University of Vienna, AKH Vienna, Wahringer Gurterl 18-20, 1090 Vienna, Austria
b Department of Cardiothoracic and Vascular Anaesthesia, Medical University of Vienna, 1090 Vienna, Austria
Received 3 February 2004; received in revised form 15 April 2004; accepted 21 April 2004.
* Corresponding author. Tel.: +43-140-400-5620; fax: +43-140-400-5640
e-mail: t9204604{at}hotmail.com
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.
Key Words: Ascending thoracic aorta • Surgical repair • ICU stay • Hospital stay • Peri-operative management
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