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. 2013;8(3):e57713.
doi: 10.1371/journal.pone.0057713. Epub 2013 Mar 1.

Long-term results after proximal thoracic aortic redo surgery

Martin Czerny  1 , Ilan Barchichat, Katharina Meszaros, Gottfried H Sodeck, Alberto Weber, David Reineke, Lars Englberger, Florian Schönhoff, Alexander Kadner, Hansjörg Jenni, Jürg Schmidli, Thierry P Carrel
Affiliations

Long-term results after proximal thoracic aortic redo surgery

Martin Czerny et al. PLoS One. 2013.

Abstract

Objective: To evaluate early and mid-term results in patients undergoing proximal thoracic aortic redo surgery.

Methods: We analyzed 60 patients (median age 60 years, median logistic EuroSCORE 40) who underwent proximal thoracic aortic redo surgery between January 2005 and April 2012. Outcome and risk factors were analyzed.

Results: In hospital mortality was 13%, perioperative neurologic injury was 7%. Fifty percent of patients underwent redo surgery in an urgent or emergency setting. In 65%, partial or total arch replacement with or without conventional or frozen elephant trunk extension was performed. The preoperative logistic EuroSCORE I confirmed to be a reliable predictor of adverse outcome- (ROC 0.786, 95%CI 0.64-0.93) as did the new EuroSCORE II model: ROC 0.882 95%CI 0.78-0.98. Extensive individual logistic EuroSCORE I levels more than 67 showed an OR of 7.01, 95%CI 1.43-34.27. A EuroSCORE II larger than 28 showed an OR of 4.44 (95%CI 1.4-14.06). Multivariate logistic regression analysis identified a critical preoperative state (OR 7.96, 95%CI 1.51-38.79) but not advanced age (OR 2.46, 95%CI 0.48-12.66) as the strongest independent predictor of in-hospital mortality. Median follow-up was 23 months (1-52 months). One year and five year actuarial survival rates were 83% and 69% respectively. Freedom from reoperation during follow-up was 100%.

Conclusions: Despite a substantial early attrition rate in patients presenting with a critical preoperative state, proximal thoracic aortic redo surgery provides excellent early and mid-term results. Higher EuroSCORE I and II levels and a critical preoperative state but not advanced age are independent predictors of in-hospital mortality. As a consequence, age alone should no longer be regarded as a contraindication for surgical treatment in this particular group of patients.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Logistic regression model to assess the predictive power of EuroSCORE I levels.
Figure 2
Figure 2. One year and five year actuarial survival rates.
See this image and copyright information in PMC

References

    1. Luciani N, De Geest R, Anselmi A, Glieca F, De Paulis S, et al. (2011) Results of reoperation on the aortic root and the ascending aorta. Ann Thorac Surg 92: 898–903. - PubMed
    1. Girardi LN, Krieger KH, Mack CA, Lee LY, Tortolani AJ, et al. (2006) Reoperations on the ascending aorta and the aortic root in patients with previous cardiac surgery. Ann Thorac Surg 82: 1407–12. - PubMed
    1. Etz CD, Plestis KA, Homann TM, Bodian CA, Di Luozzo G, et al. (2008) Reoperative aortic root and transverse arch procedures: a comparison with contemporaneous primary operations. J Thorac Cardiovasc Surg136: 860–7. - PubMed
    1. Silva J, Maroto L, Carnero M, Vilacosta I, Cobiella J, et al. (2010) Ascending aorta and aortic root reoperations: are outcomes worse than first time surgery? Ann Thorac Surg 90: 555–60. - PubMed
    1. Dougenis D, Daily BB, Kouchoukos NT (1997) Reoperations on the aortic root and ascending aorta. Ann Thorac Surg 64: 986–92. - PubMed

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