Aortitis Increases the Risk of Surgical Complications and Re-Operations After Major Aortic Surgery

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Aortitis, defined as inflammation of the aorta, can lead to aneurysms and dissections. Intra-operative sampling is essential for diagnosis, with many cases presenting asymptomatically as clinically isolated aortitis. Previous studies investigating aortitis in major aortic surgery have been limited by low intra-operative sampling. We performed an 11-year, retrospective, cross-sectional study to investigate the true prevalence of aortitis in thoracic aortic aneurysms and dissections by analysing all major aortic operations performed in a single centre. We collected medical histories, histological reports, post-operative outcomes and follow-up data; 537 patients met the inclusion criteria, representing an 88% histological sampling rate. The prevalence of aortitis was 10.6% (n = 57), of which 75% were clinically isolated. The re-operation rate in aortitis was twice that of non-aortitis patients (17.5% vs. 9.4%, p = 0.054). Multivariate logistic regression identified increased age, female sex, current smoking, and other inflammatory diseases as significantly associated with aortitis, with a bicuspid aortic valve associated with a significantly decreased likelihood of aortitis. The true prevalence of aortitis is likely higher than reported in previous studies, with our study showing twice the prevalence found in previous studies with lower sampling rates. Due to the increased re-intervention in aortitis, specialist multi-disciplinary follow-up and aortitis centres should be formed.