Analyzing Operative Outcomes for Proximal Aortic Replacement

Analyzing Operative Outcomes for Proximal Aortic Replacement

Morbidity and mortality from proximal aortic replacement remain high when compared with other surgical procedures, but research indicates that patient outcomes have improved over the last 30 years. Much of this has been attributed to advances in operative approaches, perioperative care, and increased surveillance. For patients undergoing these procedures, better character­izing outcomes and determin­ing predictors of mortality and major morbidity are important for clinicians managing this patient population. In the Journal of the American College of Cardiology, G. Chad Hughes, MD, and colleagues had an analysis published that looked at operative outcomes for ascending aorta and arch replacement on a national scale. The study also reviewed risk factors for postoperative mortality and major morbidity. “Our study provides a broad overview of the current practices and outcomes for proximal aortic replacement in North America,” says Dr. Hughes. “With more than 45,000 patients from the Society of Thoracic Surgeons Database involved in our analysis, we have the largest cohort of proximal aortic replacements that have been reported to date.”   Examining Outcomes for Proximal Aortic Replacement In the study by Dr. Hughes and colleagues, roughly 60% of proximal aortic replacement cases were elective, 20% were urgent, and 20% were emergent. From 2004 to 2009, the number of centers that reported performing aortic replacement, as well as the overall number of patients treated, increased dramatically, although the average number of patients treated per center remained relatively constant. In 2004, 285 centers in North America treated 2,121 patients. In 2008, there were 806 centers that treated 11,033 patients. “Outcomes were excellent for elective proximal aortic replacement but sharply deteriorated when the procedure was...

Identifying Acute Aortic Dissection Patients

It has been estimated that 5,000 to 10,000 aortic dissections occur in patients each year in the United States, and nearly one-third of these individuals will die before hospital discharge. Despite recent advances in diagnostic tools and surgery, the tearing of the aorta can be challenging for even the most experienced cardiovascular specialists to diagnose. In 2010, the American Heart Association and American College of Cardiology released clinical guidelines—developed in collaboration with 10 professional societies—for the diagnosis and management of thoracic aortic disease, emphasizing high-risk clinical features that indicate the presence of acute aortic dissection (AAD). Validation of these risk markers had yet to occur until the results of a study by the University of Michigan Cardiovascular Center (UMCC) published in 2011 in Circulation, which suggested patients with certain characteristics were likely to be suffering from an aortic dissection. “Over the past 20 years, much progress has been made in various facets of thoracic aortic disease,” says Kim A. Eagle, MD, co-author of both the guidelines for thoracic aortic disease and the aforementioned UMCC study. “This includes a better understanding of the natural history of thoracic aortic disease and the potential genetic factors that may underlie some of the aortic problems of the thorax. There has also been an evolution of modern imaging techniques for more reliable and speedy diagnoses and follow-up. Furthermore, new strategies for both medical and interventional therapy have emerged.” (see also, Strategies for Managing Thoracic Aortic Disease With Surgery). When compared with coronary heart disease, hypertension, or heart failure, thoracic aortic diseases are rarer, and therefore, probably encountered by practitioners less frequently. “As a result,”...