Quando intervenire sulla aorta ascendente?
Data pubblicazione: 12-gen-2013 14.36.28
Contemporary Results for Proximal Aortic Replacement in North America
Contemporary Results for Proximal Aortic Replacement in North America
Judson B. Williams, MD, MHS,*† Eric D. Peterson, MD, MPH,*‡ Yue Zhao, PHD,*
Judson B. Williams, MD, MHS,*† Eric D. Peterson, MD, MPH,*‡ Yue Zhao, PHD,*
Sean M. O’Brien, PHD,* Nicholas D. Andersen, MD,† D. Craig Miller, MD,§ Edward P. Chen, MD, G. Chad Hughes, MD†
Sean M. O’Brien, PHD,* Nicholas D. Andersen, MD,† D. Craig Miller, MD,§ Edward P. Chen, MD, G. Chad Hughes, MD†
The purpose of this study was to characterize operative outcomes for ascending aorta and arch replacement on a national scale and to develop risk models for mortality and major morbidity.
The purpose of this study was to characterize operative outcomes for ascending aorta and arch replacement on a national scale and to develop risk models for mortality and major morbidity.
Contemporary outcomes for ascending aorta and arch replacement in North America are unknown.
Contemporary outcomes for ascending aorta and arch replacement in North America are unknown.
We queried the Society of Thoracic Surgeons Database for patients undergoing ascending aorta (with or without root) with or without arch replacement from 2004 to 2009. The database captured 45,894 cases, including 12,702 root, 22,048 supracoronary ascending alone, 6,786 ascending plus arch, and 4,358 root plus arch. Baseline characteristics and clinical outcomes were analyzed. A parsimonious multivariable logistic regression model was constructed to predict risks of mortality and major morbidity.
We queried the Society of Thoracic Surgeons Database for patients undergoing ascending aorta (with or without root) with or without arch replacement from 2004 to 2009. The database captured 45,894 cases, including 12,702 root, 22,048 supracoronary ascending alone, 6,786 ascending plus arch, and 4,358 root plus arch. Baseline characteristics and clinical outcomes were analyzed. A parsimonious multivariable logistic regression model was constructed to predict risks of mortality and major morbidity.
Operative mortality was 3.4% for elective cases and 15.4% for nonelective cases. A risk model for operative mortality (c-index 0.81) revealed a risk-adjusted odds ratio for death after emergent versus elective operation of 5.9 (95% confidence interval: 5.3 to 6.6). Among elective patients, end-stage renal disease and reoperative sta- tus were the strongest predictors of mortality (adjusted odds ratios: 4.0 [95% confidence interval: 2.6 to 6.4] and 2.3 (95% confidence interval: 1.9 to 2.7], respectively; p 0.0001).
Operative mortality was 3.4% for elective cases and 15.4% for nonelective cases. A risk model for operative mortality (c-index 0.81) revealed a risk-adjusted odds ratio for death after emergent versus elective operation of 5.9 (95% confidence interval: 5.3 to 6.6). Among elective patients, end-stage renal disease and reoperative sta- tus were the strongest predictors of mortality (adjusted odds ratios: 4.0 [95% confidence interval: 2.6 to 6.4] and 2.3 (95% confidence interval: 1.9 to 2.7], respectively; p 0.0001).
Current outcomes for ascending aorta and arch replacement in North America are excellent for elective repair; however, results deteriorate for nonelective status, suggesting that increased screening and/or lowering thresholds for elective inter- vention could potentially improve outcomes. The predictive models presented may serve clinicians in counseling
Current outcomes for ascending aorta and arch replacement in North America are excellent for elective repair; however, results deteriorate for nonelective status, suggesting that increased screening and/or lowering thresholds for elective inter- vention could potentially improve outcomes. The predictive models presented may serve clinicians in counseling
patients. (J Am Coll Cardiol 2012;60:1156–62) © 2012 by the American College of Cardiology Foundation
patients. (J Am Coll Cardiol 2012;60:1156–62) © 2012 by the American College of Cardiology Foundation