Impact of pre-existing conditions, age and the length of cardiopulmonary bypass on postoperative outcome after repair of the ascending aorta and aortic arch for aortic aneurysms and dissections

Abstract

Repair of the ascending aorta and aortic arch carries a high morbidity and mortality, which can be complicated by the often emergent nature of the intervention. We retrospectively evaluated the morbidity, mortality, and long-term survival in 101 patients who underwent repair of ascending aorta and aortic arch. Depending on the urgency of the operation, the patients were categorized as elective (EL, n=82) or emergent (EM, n=19). Log-rank-list and SPS were used to evaluate the data. The average age was 58+/-16 years. The aortic diameter was 5.5+/-1 cm in the EL group and 6.1+/-1.4 cm for EM group. The aortic dissection in EL and EM groups was 15% and 79%, respectively. The mean circulatory arrest time (n=32 patients) was 38+/-18.5 min. The overall 30-day mortality was 4%: 0% for the EL group and 26% for the EM group. The overall 6-month mortality was 8%: 3.7% and 26% in EL and EM groups, respectively. Overall CVA was 3%: 0% in the EL group and 15.7% in the EM group. The mean CPB time was 176+/-81 min. The prolonged CPB time correlated with increased need for blood transfusion. The LOS was 12+/-8 days and correlated with increasing age (95% CI 0.06860-0.2307, P=0.0004), with NYHA stage of patients at the time of surgery (95% confidence intervals, 1.328-4.202, P=0.0003), with left ventricular ejection fraction (95% CI 0.2357 to -0.003029, P=0.0442) and with postoperative atrial fibrillation (95% CI 0.1192-0.4745, P=0.0018). The average ICU stay was 123+/-145 h. A prolonged CPB time resulted in extended ICU stay (95% CI 0.3655-1.486, P=0.0014). Further, the length of ICU stay correlated with NYHA status (95% CI 19.98-73.42, P=0.0008), age (95% confidence intervals 0.01668-3.761, P=0.0477), urgency of surgery (95% CI 65.00-124.0, P<0.0001), and length of CPB time (95% CI 0.3655-1.486, P=0.0014). Emergent operations are associated with high morbidity and mortality. Pre-existing heart failure, advanced age, and prolonged cardiopulmonary bypass are associated with prolonged monitoring in the ICU.