Improved clinical outcomes after operation of the proximal aorta: a 10-year experience

Background. This study evaluated the impact of recent advances (particularly noninvasive diagnosis, retrograde cerebral perfusion, heparin-bonded circuits, and use of collagen-impregnated grafts and antifibrinolytic agents) on clinical outcomes of patients undergoing proximal aortic operations. Meth...

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Veröffentlicht in:The Annals of thoracic surgery 1999-04, Vol.67 (4), p.1030-1037
Hauptverfasser: Shapira, Oz M, Aldea, Gabriel S, Cutter, Susan M, Fitzgerald, Carmel A, Lazar, A.N.P.Harold L, Shemin, Richard J
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container_end_page 1037
container_issue 4
container_start_page 1030
container_title The Annals of thoracic surgery
container_volume 67
creator Shapira, Oz M
Aldea, Gabriel S
Cutter, Susan M
Fitzgerald, Carmel A
Lazar, A.N.P.Harold L
Shemin, Richard J
description Background. This study evaluated the impact of recent advances (particularly noninvasive diagnosis, retrograde cerebral perfusion, heparin-bonded circuits, and use of collagen-impregnated grafts and antifibrinolytic agents) on clinical outcomes of patients undergoing proximal aortic operations. Methods. One hundred eight consecutive patients undergoing 111 proximal aortic operations over 10 years were studied. The cohort was divided into two groups: early, 1987 to 1993 and late, 1994 to 1997. Results. Baseline patients profiles, indications for operation (aneurysm, 66 patients; dissection, 45 patients), priority of the operation, and surgical procedures were comparable for both groups. Mortality and morbidity for the entire cohort were 13.5% (15 of 111) and 66% (73 of 111), respectively. Compared with the early group, the late group was characterized by significantly higher use of noninvasive diagnostic modalities (69% versus 10%), exclusive use of heparin-bonded circuits and collagen-impregnated grafts (100% versus 0% for both), use of antifibrinolytic agents (79% versus 8%), and the introduction of retrograde cerebral perfusion (43% versus 0%) (p < 0.00001 for all). These changes in practice were associated with a substantial decrease in operative mortality (26% [13 of 49] versus 3% [2 of 62], p = 0.001), overall morbidity (77% [38 of 49] versus 56% [35 of 62], p = 0.02), blood transfusions (55.6 ± 48 donor units versus 29.3 ± 35 donor units, p = 0.003), and a shorter hospital stay (21.6 ± 31 days versus 12.1 ± 15 days, p = 0.07). Average long-term follow-up for 99% (107 of 108) of patients was 29.6 ± 30 months (1 to 120 months). Ten-year actuarial survival was 57.3% ± 8% with 93% being in New York Heart Association functional class I or II. Conclusions. Recent advances, particularly noninvasive diagnosis and improved operative management, have led to a substantial reduction in mortality and morbidity after proximal aortic operation. Improved short- and long-term outcomes were achieved both in acute dissection and aneurysm procedures, although patients remain at risk for long-term distal aortic complications.KEY WORDS: Proximal aorta, Diagnosis, Management, Surgery, Clinical Outcomes.
doi_str_mv 10.1016/S0003-4975(99)00066-1
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This study evaluated the impact of recent advances (particularly noninvasive diagnosis, retrograde cerebral perfusion, heparin-bonded circuits, and use of collagen-impregnated grafts and antifibrinolytic agents) on clinical outcomes of patients undergoing proximal aortic operations. Methods. One hundred eight consecutive patients undergoing 111 proximal aortic operations over 10 years were studied. The cohort was divided into two groups: early, 1987 to 1993 and late, 1994 to 1997. Results. Baseline patients profiles, indications for operation (aneurysm, 66 patients; dissection, 45 patients), priority of the operation, and surgical procedures were comparable for both groups. Mortality and morbidity for the entire cohort were 13.5% (15 of 111) and 66% (73 of 111), respectively. Compared with the early group, the late group was characterized by significantly higher use of noninvasive diagnostic modalities (69% versus 10%), exclusive use of heparin-bonded circuits and collagen-impregnated grafts (100% versus 0% for both), use of antifibrinolytic agents (79% versus 8%), and the introduction of retrograde cerebral perfusion (43% versus 0%) (p &lt; 0.00001 for all). These changes in practice were associated with a substantial decrease in operative mortality (26% [13 of 49] versus 3% [2 of 62], p = 0.001), overall morbidity (77% [38 of 49] versus 56% [35 of 62], p = 0.02), blood transfusions (55.6 ± 48 donor units versus 29.3 ± 35 donor units, p = 0.003), and a shorter hospital stay (21.6 ± 31 days versus 12.1 ± 15 days, p = 0.07). Average long-term follow-up for 99% (107 of 108) of patients was 29.6 ± 30 months (1 to 120 months). Ten-year actuarial survival was 57.3% ± 8% with 93% being in New York Heart Association functional class I or II. Conclusions. Recent advances, particularly noninvasive diagnosis and improved operative management, have led to a substantial reduction in mortality and morbidity after proximal aortic operation. Improved short- and long-term outcomes were achieved both in acute dissection and aneurysm procedures, although patients remain at risk for long-term distal aortic complications.KEY WORDS: Proximal aorta, Diagnosis, Management, Surgery, Clinical Outcomes.</description><identifier>ISSN: 0003-4975</identifier><identifier>EISSN: 1552-6259</identifier><identifier>DOI: 10.1016/S0003-4975(99)00066-1</identifier><identifier>PMID: 10320247</identifier><identifier>CODEN: ATHSAK</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Aneurysm, Dissecting - diagnosis ; Aneurysm, Dissecting - surgery ; Antifibrinolytic Agents - administration &amp; dosage ; Aorta - surgery ; Aortic Aneurysm - diagnosis ; Aortic Aneurysm - surgery ; Aortography ; Biological and medical sciences ; Blood Transfusion ; Collagen - administration &amp; dosage ; Female ; Heparin - administration &amp; dosage ; Humans ; Length of Stay ; Magnetic Resonance Imaging ; Male ; Medical sciences ; Middle Aged ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the heart ; Tomography, X-Ray Computed ; Treatment Outcome</subject><ispartof>The Annals of thoracic surgery, 1999-04, Vol.67 (4), p.1030-1037</ispartof><rights>1999 The Society of Thoracic Surgeons</rights><rights>1999 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c568t-b17de2a39ff9eed73f97eee21477191eeec9a4280daec72d1aef9b4c6b86b413</citedby><cites>FETCH-LOGICAL-c568t-b17de2a39ff9eed73f97eee21477191eeec9a4280daec72d1aef9b4c6b86b413</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/S0003-4975(99)00066-1$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&amp;idt=1775600$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/10320247$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Shapira, Oz M</creatorcontrib><creatorcontrib>Aldea, Gabriel S</creatorcontrib><creatorcontrib>Cutter, Susan M</creatorcontrib><creatorcontrib>Fitzgerald, Carmel A</creatorcontrib><creatorcontrib>Lazar, A.N.P.Harold L</creatorcontrib><creatorcontrib>Shemin, Richard J</creatorcontrib><title>Improved clinical outcomes after operation of the proximal aorta: a 10-year experience</title><title>The Annals of thoracic surgery</title><addtitle>Ann Thorac Surg</addtitle><description>Background. This study evaluated the impact of recent advances (particularly noninvasive diagnosis, retrograde cerebral perfusion, heparin-bonded circuits, and use of collagen-impregnated grafts and antifibrinolytic agents) on clinical outcomes of patients undergoing proximal aortic operations. Methods. One hundred eight consecutive patients undergoing 111 proximal aortic operations over 10 years were studied. The cohort was divided into two groups: early, 1987 to 1993 and late, 1994 to 1997. Results. Baseline patients profiles, indications for operation (aneurysm, 66 patients; dissection, 45 patients), priority of the operation, and surgical procedures were comparable for both groups. Mortality and morbidity for the entire cohort were 13.5% (15 of 111) and 66% (73 of 111), respectively. Compared with the early group, the late group was characterized by significantly higher use of noninvasive diagnostic modalities (69% versus 10%), exclusive use of heparin-bonded circuits and collagen-impregnated grafts (100% versus 0% for both), use of antifibrinolytic agents (79% versus 8%), and the introduction of retrograde cerebral perfusion (43% versus 0%) (p &lt; 0.00001 for all). These changes in practice were associated with a substantial decrease in operative mortality (26% [13 of 49] versus 3% [2 of 62], p = 0.001), overall morbidity (77% [38 of 49] versus 56% [35 of 62], p = 0.02), blood transfusions (55.6 ± 48 donor units versus 29.3 ± 35 donor units, p = 0.003), and a shorter hospital stay (21.6 ± 31 days versus 12.1 ± 15 days, p = 0.07). Average long-term follow-up for 99% (107 of 108) of patients was 29.6 ± 30 months (1 to 120 months). Ten-year actuarial survival was 57.3% ± 8% with 93% being in New York Heart Association functional class I or II. Conclusions. Recent advances, particularly noninvasive diagnosis and improved operative management, have led to a substantial reduction in mortality and morbidity after proximal aortic operation. Improved short- and long-term outcomes were achieved both in acute dissection and aneurysm procedures, although patients remain at risk for long-term distal aortic complications.KEY WORDS: Proximal aorta, Diagnosis, Management, Surgery, Clinical Outcomes.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Aneurysm, Dissecting - diagnosis</subject><subject>Aneurysm, Dissecting - surgery</subject><subject>Antifibrinolytic Agents - administration &amp; dosage</subject><subject>Aorta - surgery</subject><subject>Aortic Aneurysm - diagnosis</subject><subject>Aortic Aneurysm - surgery</subject><subject>Aortography</subject><subject>Biological and medical sciences</subject><subject>Blood Transfusion</subject><subject>Collagen - administration &amp; dosage</subject><subject>Female</subject><subject>Heparin - administration &amp; dosage</subject><subject>Humans</subject><subject>Length of Stay</subject><subject>Magnetic Resonance Imaging</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. 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Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the heart</topic><topic>Tomography, X-Ray Computed</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Shapira, Oz M</creatorcontrib><creatorcontrib>Aldea, Gabriel S</creatorcontrib><creatorcontrib>Cutter, Susan M</creatorcontrib><creatorcontrib>Fitzgerald, Carmel A</creatorcontrib><creatorcontrib>Lazar, A.N.P.Harold L</creatorcontrib><creatorcontrib>Shemin, Richard J</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Annals of thoracic surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Shapira, Oz M</au><au>Aldea, Gabriel S</au><au>Cutter, Susan M</au><au>Fitzgerald, Carmel A</au><au>Lazar, A.N.P.Harold L</au><au>Shemin, Richard J</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Improved clinical outcomes after operation of the proximal aorta: a 10-year experience</atitle><jtitle>The Annals of thoracic surgery</jtitle><addtitle>Ann Thorac Surg</addtitle><date>1999-04-01</date><risdate>1999</risdate><volume>67</volume><issue>4</issue><spage>1030</spage><epage>1037</epage><pages>1030-1037</pages><issn>0003-4975</issn><eissn>1552-6259</eissn><coden>ATHSAK</coden><abstract>Background. This study evaluated the impact of recent advances (particularly noninvasive diagnosis, retrograde cerebral perfusion, heparin-bonded circuits, and use of collagen-impregnated grafts and antifibrinolytic agents) on clinical outcomes of patients undergoing proximal aortic operations. Methods. One hundred eight consecutive patients undergoing 111 proximal aortic operations over 10 years were studied. The cohort was divided into two groups: early, 1987 to 1993 and late, 1994 to 1997. Results. Baseline patients profiles, indications for operation (aneurysm, 66 patients; dissection, 45 patients), priority of the operation, and surgical procedures were comparable for both groups. Mortality and morbidity for the entire cohort were 13.5% (15 of 111) and 66% (73 of 111), respectively. Compared with the early group, the late group was characterized by significantly higher use of noninvasive diagnostic modalities (69% versus 10%), exclusive use of heparin-bonded circuits and collagen-impregnated grafts (100% versus 0% for both), use of antifibrinolytic agents (79% versus 8%), and the introduction of retrograde cerebral perfusion (43% versus 0%) (p &lt; 0.00001 for all). These changes in practice were associated with a substantial decrease in operative mortality (26% [13 of 49] versus 3% [2 of 62], p = 0.001), overall morbidity (77% [38 of 49] versus 56% [35 of 62], p = 0.02), blood transfusions (55.6 ± 48 donor units versus 29.3 ± 35 donor units, p = 0.003), and a shorter hospital stay (21.6 ± 31 days versus 12.1 ± 15 days, p = 0.07). Average long-term follow-up for 99% (107 of 108) of patients was 29.6 ± 30 months (1 to 120 months). Ten-year actuarial survival was 57.3% ± 8% with 93% being in New York Heart Association functional class I or II. Conclusions. Recent advances, particularly noninvasive diagnosis and improved operative management, have led to a substantial reduction in mortality and morbidity after proximal aortic operation. Improved short- and long-term outcomes were achieved both in acute dissection and aneurysm procedures, although patients remain at risk for long-term distal aortic complications.KEY WORDS: Proximal aorta, Diagnosis, Management, Surgery, Clinical Outcomes.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>10320247</pmid><doi>10.1016/S0003-4975(99)00066-1</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record>
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source MEDLINE; Access via ScienceDirect (Elsevier); EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection
subjects Adult
Aged
Aged, 80 and over
Aneurysm, Dissecting - diagnosis
Aneurysm, Dissecting - surgery
Antifibrinolytic Agents - administration & dosage
Aorta - surgery
Aortic Aneurysm - diagnosis
Aortic Aneurysm - surgery
Aortography
Biological and medical sciences
Blood Transfusion
Collagen - administration & dosage
Female
Heparin - administration & dosage
Humans
Length of Stay
Magnetic Resonance Imaging
Male
Medical sciences
Middle Aged
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the heart
Tomography, X-Ray Computed
Treatment Outcome
title Improved clinical outcomes after operation of the proximal aorta: a 10-year experience
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