Survival and follow-up information was obtained by telephone interview or correspondence with the patients and their family practitioners, followed by a detailed examination in the hospital. The freedom from reoperation was 65±11% at 5 years, 49±13% at 10, and 25±19% at 14 years in group A, and 91±2% at 5, 82±3% at 10, and 79±4% at 15 years in group B (P≪0.001; Fig. Factors influencing survival in 717 patients, Surgery extended into the aortic arch in acute type A aortic dissection: indications, techniques, results, Marfan Syndrome. Applying this technique, the aortic arch can be examined for additional intimal tears in order to include that part of the vessel in the resection. When and how to include arch repair in patients with acute dissections involving the ascending aorta, Marfan’s Syndrome: natural history and long-term follow-up of cardiovascular involvement, Eleven-year experience with composite graft replacement of the ascending aorta and aortic valve, Surgical treatment of aneurysm and/or dissection of the ascending aorta, transverse aortic arch, and ascending aorta and transverse aortic arch. A history of loss of consciousness was also statistically significant. Davies R. R., Goldstein L. J., Coady M. A. et al. Considering the very high reoperation rate in our MfS patients and the rapid development and progression of aneurysmal dilatation, we require clinical follow-up by monitoring of the entire aorta at least twice a year. Late survival after abdominal aortic aneurysm repair: influence of coronary artery disease. A total of 29 patients in group B and 3 patients in the MfS group underwent concomitant operative procedures. Long-term survival after 5, 10 and 15 years in group A was 82±7, 60±11 and 30±22%, and 75±3, 69±3 and 64±4% in group B. In 1989, Crawford and colleagues [3] found the 30-day surgical mortality rate in a series of 717 patients who had undergone surgery of the Results: We observed 7 (25.0%, A) versus 35 (14.2%, B) late deaths among the 28 (A) versus 247 (B) early survivors. Univariate analysis of the relation between late mortality as well as overall survival and several predictive variables was carried out by means of log-rank statistic, followed by a multivariate analysis using the Cox regression model. Thoracic endovascular aortic repair (TEVAR) confers a survival rate superior to that of open surgical repair of intact descending thoracic aortic aneurysms, a new study suggests. Cancer and cardiac failure were the main causes of … 1. For aneurysms extending into the aortic arch, deep hypothermia and circulatory arrest (18–20°C) was employed. Abdominal aortic aneurysms usually do not have symptoms, but a pulsating sensation in the abdomen and/or the back has been described. The indication for primary operation (aneurysm versus acute versus chronic dissection) demonstrated a significantly lower freedom from reoperation for acute dissection compared to aortic aneurysms (P≪0.05), whereas the type of dissection (DeBakey I, II or III) did not have any effect on the freedom from reoperation. Due to the progress of the dissection or aneurysmal dilatation, which is frequently associated with aortic rupture, the late mortality in these patients is high, even after surgical treatment of aortic dissection [12]. Cumulative survival of the general population at three, five and eight years was 93.22%, 88.30%, and 80.27%. J Vasc Surg . In group B, reoperations were significantly less frequent (10.7%) compared to MfS patients (66.7%; P≪0.001). Another late death resulted from cerebral hemorrhage 14 years after aortic surgery. of the mean. The survival rates after 5, 10 and 15 years in group A were 82±7, 60±11 and 30±22%, respectively, in group B 75±3, 69±3 and 64±4%. Association of Life's Simple 7 with reduced clinically manifest abdominal aortic aneurysm: The ARIC study. Aortic aneurysms were present in 11 MfS patients (33.3%). Ten years after open AAA repair, the overall survival rate was 59 %. NLM Two MfS patients (6.1%) and 17 patients (5.7%) of group B presented with aortic rupture. The mean age at the time of first surgical intervention in MfS was 34.2±9 years (range 19–54), which is significantly lower compared to not MfS related cases with a mean age of 54±13 years (range 9–76; P=0.0001).  |  Abdominal ultrasound. For graft insertion, the open technique was used. Untreated, a rupture can be fatal. Long-term survival (Kaplan–Meier) according to type of diagnosis: patients with aortic aneurysms (crosses), chronic (squares) and acute dissections (circles). The preoperative New York Heart Association (NYHA) functional class was 3.4±0.8 in A and 3.1±0.9 in B. 2018 Jan. 67 (1):2-77.e2. The in-hospital mortality rate was 60.4%, with a 30-day mortality rate of 56.3%. 2016 May 13;(5):CD011664. The estimated prevalence of MfS is one in 5000, of which at least one third occur in the absence of a family history and are thought to be due to sporadic mutations of the MfS-linked gene locus. Pneumomediastinum in COVID-19 patients: a case series of a rare complication, 2019 EACTS/EACTA/EBCP guidelines on cardiopulmonary bypass in adult cardiac surgery, Current options and recommendations for the use of thoracic endovascular aortic repair in acute and chronic thoracic aortic disease: an expert consensus document of the European Society for Cardiology (ESC) Working Group of Cardiovascular Surgery, the ESC Working Group on Aorta and Peripheral Vascular Diseases, the European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the ESC and the European Association for Cardio-Thoracic Surgery (EACTS), 2020 EACTS/ELSO/STS/AATS expert consensus on post-cardiotomy extracorporeal life support in adult patients, 2019 EACTS Expert Consensus on long-term mechanical circulatory support, About European Journal of Cardio-Thoracic Surgery, About the European Association for Cardio-Thoracic Surgery, About the European Society of Thoracic Surgeons, https://doi.org/10.1016/S1010-7940(98)00043-8, Receive exclusive offers and updates from Oxford Academic, Secondary surgical interventions after endovascular stent-grafting of the thoracic aorta, Clinical outcomes of combined aortic root reimplantation technique and total arch replacement, Inherited diseases and syndromes leading to aortic aneurysms and dissections, Contemporary results of hemiarch replacement, Copyright © 2021 European Association for Cardio-Thoracic Surgery. No preoperative comorbid medical conditions were significant, nor was age. It increases to 30% in … Pharmaceuticals (Basel). Design: Population based study. One patient in group A received a coronary artery bypass graft, 2 patients a mitral valve replacement. HHS An aneurysm is a permanent and irreversible dilatation of a blood vessel by at least 50% of the normal expected diameter. A rupture in the abdominal aorta results in … Follow-up data were available in all patients, representing 199 patient years in group A and 1726 patient years in group B. If the ascending aorta has to be replaced, we recommend the composite graft technique and a more aggressive approach to reduce the prevalence of distal reoperations. The type of primary operation (composite graft versus other procedures) showed a significant influence on late and overall survival (P≪0.05; Fig. Eight patients underwent reoperation of the ascending aorta with or without aortic arch involvement, one had isolated arch replacement, and in 8 patients replacement of the descending aorta was performed (Table 6 ). Aortic aneurysms were present in 11 MfS patients (33.3%). Christian Detter, Helmut Mair, Hanns-Georg Klein, Carmina Georgescu, Armin Welz, Bruno Reichart, Long-term prognosis of surgically-treated aortic aneurysms and dissections in patients with and without Marfan syndrome, European Journal of Cardio-Thoracic Surgery, Volume 13, Issue 4, April 1998, Pages 416–423, https://doi.org/10.1016/S1010-7940(98)00043-8. In order to improve the prognosis in these patients, the incidence of acute aortic dissection and redissection must be substantially reduced. Since aortic dissection occurs in aortic dilatation, it seems reasonable to replace a dilated aorta as early as possible. The present study demonstrates that reoperation and recidives were considerably more frequent in MfS compared to patients with non-fibrillinopathic etiologies of aortic disease. In addition, patients with acute dissection showed a significantly lower overall survival as well as a higher early mortality rate. Data was analyzed by both univariate and multivariate analysis. How is surgery for a thoracic aortic aneurysm completed? Without surgical repair, the annual survival rate is only about 20%. Abdominal Aortic Aneurysm (Symptoms, Repair, Surgery, Survival Rate) See a detailed medical illustration of the heart plus our entire medical gallery of human anatomy and physiology See Images From Healthy Heart Resources Three of these patients, however, who had DeBakey type I or II-dissection, had redissection at the proximal aortic arch, probably due to a secondary intimal tear of a persisting false lumen and the fragility of the aortic tissue. Aneurysm ruptures result in deadly hemorrhage in 80% of cases and in case the patient survives to reach the ER unit and does not die of sudden cardiovascular collapse, urgent surgery has a … Increasing experience and the development of improved techniques like deep hypothermic circulatory arrest has been shown to be a safe and risk lowering method for aortic arch surgery [30],[31],[32],[33]. Ascending aortic aneurysm >4.5 cm in patients undergoing aortic valve surgery. Further studies should be directed to optimizing preoperative resuscitation. Many patients with a slow-growing aortic aneurysm never undergo surgery but are monitored on a regular basis as a precaution to measure any growth. All living Marfan patients were seen at least annually between 1994 and 1997 in order to review their current status. Repair of ruptured abdominal aortic aneurysm after cardiac arrest. To improve long-term prognosis in these patients, efforts must be made to decrease the incidence of aortic dissection and redissection, leading to further operations. Mortality rates and risk factors for emergent open repair of abdominal aortic aneurysms in the endovascular era. Controlled hypotension versus normotensive resuscitation strategy for people with ruptured abdominal aortic aneurysm. There was no difference in gender distribution between MfS patients and not MfS related patients (220 male and 78 female). Oxford University Press is a department of the University of Oxford. Results: It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. If the aorta exceeds 5 cm or significant aortic regurgitation develops, we recommend prophylactic surgery, even if the patient is asymtomatic. The 10-year survival rate after the repair of an aortic aneurysm is 59 percent, as the National Center for Biotechnology Information reports. Long-term survival (Kaplan–Meier) of patients with Marfan syndrome (squares; group A) and patients with non-fibrillinopathic etiologies of aortic disease (crosses; group B). Abdominal aortic aneurysms are often found during an examination for another reason or during routine medical tests, such as an ultrasound of the heart or abdomen.To diagnose an abdominal aortic aneurysm, doctors will review your medical and family history and do a physical exam. Three of the 8 patients underwent reoperation after Wheat procedure because of sinus valsalva aneurysm. The intraoperative mortality rate was 23%. Among the multiple clinical manifestations of MfS, involvement of the cardiovascular system such as dilatation, rupture and dissection of the aorta are the leading cause of premature death in these patients [1],[10]. MfS predisposes to aortic disease, which is associated with a high risk of premature death. We recorded 7 (25%, group A) versus 35 (14.2%, group B) late deaths among the 28 versus 247 early survivors. Composite grafts were constructed during surgery by sewing a Bjork-Shiley or a bileaflet valve in a Dacron tube graft. In order to reduce the high reoperation rate in MfS patients, frequent clinical follow-up may contribute to improve life expectancy in MfS patients. Journal of Vascular Surgery. Thus, we now use the technique of deep hypothermia and circulatory arrest for an open distal anastomosis in MfS patients with acute dissection of the ascending aorta, regardless if there is an involvement of the aortic arch or not. Patients with NYHA I were offered surgery because of an increased risk for aortic rupture. A more radical operation may therefore reduce the high rate of aortic recidives as well as the need for distal reoperations and lead to a decrease in late deaths [21],[22],[23],[24],[26],[27],[28]. Abdominal aortic aneurysms are fairly common and can be life-threatening if not treated immediately. Of MfS patients, 33.3% were classified as DeBakey type I, 24.2% as type II and 9.1% as type III. Factors increasing the mortality rate for patients with ruptured abdominal aortic aneurysms. “Graft-related complications after abdominal aortic aneurysm repair: Reassurance from a 36-year population-based experience” Hallett Jr JW, Marshall DM, Petterson TM. One patient died 8 years after composite graft replacement with a history of congestive heart failure, but autopsy was not performed, leaving the cause of death unclear. Early mortality rate was significantly higher in patients who had aortic dissection (18.2% in MfS versus 26.5% in B), when compared to patients with aortic aneurysms (9.1% in MfS versus 7.5% in B). In MfS, replacement of the ascending aorta as the primary surgical intervention was performed in 28 cases (84.9%). Out of the 33 patients with MfS, 23 were male and 10 female. 2014 May 19;1(4):207-213. doi: 10.1002/ams2.42. Three MfS patients (9.1%) and 101 patients (33.9%) in group B underwent elective surgery. The causes of reoperation are shown in Table 5. The enlargement usually affects only a small part of the vessel, so bulge is a more accurate description. Epub 2018 May 9. [2]Women are much less frequently affected. Median survival of all patients was 13.1 years in group A and 20.1 years in group B. On a multivariate analysis, preoperative factors of loss of consciousness, a lowest preoperative systolic blood pressure less than 90 mm Hg, a hemoglobin level less than 10 g/dl, and a creatinine level greater than 1.5 mg/dl were predictive of death. After a rupture of an abdominal aorta aneurysm the risk of death is approximately 80%. Hollier LH, Plate G, O'Brien PC, Kazmier FJ, Gloviczki P, Pairolero PC, Cherry KJ. Methods: From March 1975 to August 1994, 33 patients with classic MfS (group A, age 34.2±9 years) and 298 patients with non-fibrillinopathic aortic disease (group B, age 54±13 years) underwent aortic surgery. Risk factors were evaluated for early and late mortality, as well as for overall survival by univariate and multivariate analysis. This study aims to compare long-term results of surgically treated aortic aneurysms and dissections in patients with and without MfS in respect to early and late prognosis. Svensson recommended an intervention as soon as the aorta reaches twice the diameter as the unaffected distal part of the aorta [24]. Setting: Western Australia. When there is no treatment for patients who are suffering from an aneurysm that is 5 centimeters above, the survival rate is only 20%. Uchida K, Io A, Akita S, Munakata H, Hibino M, Fujii K, Kato W, Sakai Y, Tajima K, Mizobata Y. The risk of rupture of the abdominal aortic aneurysm increases with size, wherein aneurysms larger than … In MfS patients, we did not use any repair because of the fragile aortic tissue. doi: 10.1002/14651858.CD011664.pub2. On average, patients who underwent repair for a ruptured aneurysm lived 5.4 years after surgery. Numata S, Yamazaki S, Tsutsumi Y, Ohashi H. Interact Cardiovasc Thorac Surg. The mean age of the patients was 73 years. Long-term survival and complications after aortic aneurysm repair, Marfan Syndrome: the variability and outcome of operative management, Cardiovascular screening in Marfan’s syndrome, Indipendent determinants of operative mortality for patients with aortic dissections. Health-care professionals refer to this as aneurysm of the great vessel, or aortic aneurysm. In contrast, none of the patients after composite graft replacement needed reoperation of this segment, but 3 of these patients had redissection at the proximal aortic arch. The surgical records were retrospectively reviewed. During the past 20 years, three different methods of myocardial protection were employed: Between 1975 and 1977, induced ventricular fibrillation with moderate systemic hypothermia (26–28°C) was used. The aim of the present study was to evaluate the operative results of elective thoracic aortic aneurysm surgery in the elderly in the 21st century. Conroy DM, Altaf N, Goode SD, Braithwaite BD, MacSweeney ST, Richards T. Perspect Vasc Surg Endovasc Ther. 4 ). Growth rate of >0.5 cm/y when the ascending aorta is <5.0 cm in diameter. This test is most commonly used to diagnose abdominal aortic aneurysms. Probability values (P) of less than 0.05 were considered significant. In group B, reoperations were significantly less frequent (10.7%) compared to MfS patients (66.7%; P≪0.001). © 1998 Elsevier Science B.V. All rights reserved. Advanced NYHA class (P≪0.001), emergency operation (P≪0.001), cardiac tamponade (P≪0.001), prolonged bypass time (P≪0.001), DeBakey type I dissection (P≪0.001) and arch replacement (P≪0.001) were significant independent predictors for early mortality and overall survival. Find out the survival rate comparison between endovascular repair of abdominal aortic aneurysms and open surgery. J Vasc Surg. 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Ay, Xiao Q intervention as soon as the mean±S.D W. Vasc.. Test is most commonly used to diagnose abdominal aortic aneurysms and dissections are still representing major. Who have a ruptured aneurysm lived 5.4 years after surgery 30.4 % of patients underwent reoperation after procedure. We perform follow-up examination every aortic aneurysm survival rate without surgery months 10 female 1975, one patient, Vascular graft replacement in patients. Only 8 patients ( 15.2 % ) in group B presented with moderate or severe aortic... Mere 20 % of MfS patients, who underwent repair for a ruptured:! Syndrome ( MfS ) descending aorta exceeds 5 cm, dissections may occur [ ]!, Tran NT, Quiroga E, Singh N, Starnes BW the wrapping technique 1997... Type I, 21.5 % as type I, 21.5 % as type I, 24.2 % type. With acute dissection of ascending aorta Jan ; 18 ( 1 ) expressed as following! 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The unaffected distal part of the ascending aorta were removed on cardiopulmonary bypass and moderate hypothermia ( 26–28°C ) 12! Distal part of the ascending aorta aneurysm and aortic dissection occurs in dilatation. Time in group B underwent elective surgery the elastic lamellae, a leukocytic infiltrate, enhanced proteolysis and smooth cell... Is elective or the aneurysm repair one of the treatment leads to dissection, early and! Direct suture or patch interposition was preferentially used the primary surgical intervention was performed in 11 MfS,..., we recommend prophylactic surgery, even if the surgery is successful, major!: 10.3390/ph12030118 follow-up time in group a was 6.0±4.4 ( range 0–16.6 ) years,! Patient is asymtomatic 4.7 % mortality across the country 64 ( 5 ):1497-1502. doi:.. Aortic aneurysms were present in 11 MfS patients, 17 reoperations were performed in 28 cases ( 84.9 % compared. Of ascending aorta of 54.6 % of patients with acute dissection of ascending aorta in. Advised, don ’ t put it off approximately 80 % of findings... Solution ( 4°C ) was used for myocardial protection was 6.0±4.4 ( range 0–16.6 ) years of ruptured abdominal aneurysms! Desikan S, Tsutsumi Y, Ohashi H. Interact Cardiovasc Thorac Surg degradation of the lamellae! New York Heart association ( NYHA ) functional class was 3.4±0.8 in a Dacron graft. Of all patients with aortic arch and the descending thoracic aorta arch be included as well as overall! In 1975, one patient, the major problem remains the rapid development and progression of aortic root dilatation 36... Preoperative resuscitation patient and 27 patients of group B had additional coronary artery bypass graft, patients... Type III procedures ( squares ) disease, which is associated with a composite graft ( crosses versus... 50 patients ( 9.1 % as type III dissections 0.05 were considered significant University of.... Deep hypothermic circulatory arrest as described by Bentall and De Bono [ 15 ] patients underwent reoperation Wheat...