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Eur J Cardiothorac Surg 2007;31:963-969. doi:10.1016/j.ejcts.2007.01.034
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Surgical and long-term mortality in 2634 consecutive patients operated on the proximal thoracic aorta

^a Department of Cardiothoracic Surgery, Uppsala University Hospital, Sweden
^b Uppsala Clinical Research Center, Uppsala University, Sweden

Received 21 July 2006; received in revised form 19 January 2007; accepted 22 January 2007.

^_* Corresponding author. Address: Thoraxkliniken, Akademiska sjukhuset, SE-751 85, Uppsala, Sweden. Tel.: +46 18 6110000; fax: +46 18 6113926. (Email: christian.olsson{at}surgsci.uu.se).

Objective: To assess surgical and long-term mortality in a large, contemporary, unselected cohort of patients undergoing operations on the proximal thoracic aorta. Methods: Patients in the Swedish Heart Surgery register operated 1992–2004 were identified and data cross-linked with the in-hospital and cause-of-death registers. Factors associated with surgical, intermediate, and long-term mortality were studied with separate Cox analyses. Long-term survival was estimated by Kaplan-Meier analysis. Results: 2634 patients (68% men, mean age 60 years) were operated for aortic aneurysm (n = 1821, 69%) or aortic dissection (n = 813, 31%). Overall, increased age, aortic dissection, emergency operation, coronary artery bypass grafting, postoperative stroke, and postoperative renal failure were independently associated with surgical mortality. Only age was independently associated with long-term mortality. Later era of treatment (1998–2004 vs 1992–1997) was associated with lower risk only for aneurysm patients, despite similar changes in surgical approach. Long-term survival for all patients was 83% at 1 year, 77% at 5 years, and 73% at 10 years and identical for aneurysm and dissection when adjusted for surgical mortality. Conclusions: Increased age was associated with increased mortality across follow-up, implicating early surgery when possible. Results improved over time for aneurysms but not dissections; however, long-term survival was equal.

Key Words: Aortic • Aneurysm • Surgery • Survival • Risk factors

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