Chirurgia dell'aorta ascendente: Esperienza 1984-1995 della cattedra di cardiochirurgia dell'universita di milano. Analisi multivariata sui fattori di rischio per mortalita ospedaliera e ridotta sopravvivenza a distanza

Translated title of the contribution: Surgery of the ascending aorta: Multivariate analysis of risk factors for hospital mortality and reduced long-term survival

Rita Spirito, Sergio Musumeci, Alessandro Parolari, Massimo Porqueddu, Luca Dainese, Marco Agrifoglio, Carlo Antona, Francesco Alamanni, Paolo Biglioli

Research output: Contribution to journalArticle

Abstract

Between 1984 and 1995, 183 patients underwent an ascending aorta procedure at our institution. Their mean age was 60 ± 12.3 years: 116 (63.4%) patients were male, 35 (19. 1%) had a history of congestive heart failure, 72 (39.3%) presented acute type A dissection, 23 (12.6%) were redos and 63 (34.4%) were operated on an emergency basis, in-hospital mortality was 10% (12/120) in elective procedures and 36.5% (23/63) in emergency operations (p <0.0001). Multivariate stepwise logistic regression analysis identified cardiopulmonary by-pass time, emergency operation, arch replacement and the need for femoral vein cannulation at surgery as independent predictors of in- hospital death. Mean follow-up time was 54 ± 30 months (median 50 months), with a Kaplan-Meier survival of 69 ± 4% and of 60 ± 5% at 5 and 7 years, respectively. Cox regression analysis identified arch replacement, perioperative myocardial infarction, preoperative NYHA class, acute type A aortic dissection, the need for femoral vein cannulation at intervention and redo operations as independent predictors of reduced survival at follow-up. When this kind of analysis was performed on hospital survivors only, postoperative tracheostomy, reexploration for bleeding, and the occurrence of postoperative ventricular arrhythmias emerged as risk factors. In conclusion, multiple factors affect both early and long-term outcome following ascending aorta surgery. Preoperative clinical status of patients, priority of surgery and aortic dissection are the main determinants of the short-term results. Otherwise, in hospital survivors, the main determinant for long-term outcome seems to be the immediate postoperative course.

Original languageItalian
Pages (from-to)775-785
Number of pages11
JournalGiornale Italiano di Cardiologia
Volume27
Issue number8
Publication statusPublished - Aug 1997

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Hospital Mortality
Aorta
Dissection
Emergencies
Femoral Vein
Multivariate Analysis
Catheterization
Survival
Survivors
Regression Analysis
Tracheostomy
Cardiac Arrhythmias
Heart Failure
Logistic Models
Myocardial Infarction
Hemorrhage

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{c83f4fdd54274b6c8a4b4f172addcb57,
title = "Chirurgia dell'aorta ascendente: Esperienza 1984-1995 della cattedra di cardiochirurgia dell'universita di milano. Analisi multivariata sui fattori di rischio per mortalita ospedaliera e ridotta sopravvivenza a distanza",
abstract = "Between 1984 and 1995, 183 patients underwent an ascending aorta procedure at our institution. Their mean age was 60 ± 12.3 years: 116 (63.4{\%}) patients were male, 35 (19. 1{\%}) had a history of congestive heart failure, 72 (39.3{\%}) presented acute type A dissection, 23 (12.6{\%}) were redos and 63 (34.4{\%}) were operated on an emergency basis, in-hospital mortality was 10{\%} (12/120) in elective procedures and 36.5{\%} (23/63) in emergency operations (p <0.0001). Multivariate stepwise logistic regression analysis identified cardiopulmonary by-pass time, emergency operation, arch replacement and the need for femoral vein cannulation at surgery as independent predictors of in- hospital death. Mean follow-up time was 54 ± 30 months (median 50 months), with a Kaplan-Meier survival of 69 ± 4{\%} and of 60 ± 5{\%} at 5 and 7 years, respectively. Cox regression analysis identified arch replacement, perioperative myocardial infarction, preoperative NYHA class, acute type A aortic dissection, the need for femoral vein cannulation at intervention and redo operations as independent predictors of reduced survival at follow-up. When this kind of analysis was performed on hospital survivors only, postoperative tracheostomy, reexploration for bleeding, and the occurrence of postoperative ventricular arrhythmias emerged as risk factors. In conclusion, multiple factors affect both early and long-term outcome following ascending aorta surgery. Preoperative clinical status of patients, priority of surgery and aortic dissection are the main determinants of the short-term results. Otherwise, in hospital survivors, the main determinant for long-term outcome seems to be the immediate postoperative course.",
keywords = "Ascending aorta, Cardiac surgery",
author = "Rita Spirito and Sergio Musumeci and Alessandro Parolari and Massimo Porqueddu and Luca Dainese and Marco Agrifoglio and Carlo Antona and Francesco Alamanni and Paolo Biglioli",
year = "1997",
month = "8",
language = "Italian",
volume = "27",
pages = "775--785",
journal = "Giornale Italiano di Cardiologia",
issn = "0046-5968",
publisher = "Societa Italiana di Cardiologia",
number = "8",

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TY - JOUR

T1 - Chirurgia dell'aorta ascendente

T2 - Esperienza 1984-1995 della cattedra di cardiochirurgia dell'universita di milano. Analisi multivariata sui fattori di rischio per mortalita ospedaliera e ridotta sopravvivenza a distanza

AU - Spirito, Rita

AU - Musumeci, Sergio

AU - Parolari, Alessandro

AU - Porqueddu, Massimo

AU - Dainese, Luca

AU - Agrifoglio, Marco

AU - Antona, Carlo

AU - Alamanni, Francesco

AU - Biglioli, Paolo

PY - 1997/8

Y1 - 1997/8

N2 - Between 1984 and 1995, 183 patients underwent an ascending aorta procedure at our institution. Their mean age was 60 ± 12.3 years: 116 (63.4%) patients were male, 35 (19. 1%) had a history of congestive heart failure, 72 (39.3%) presented acute type A dissection, 23 (12.6%) were redos and 63 (34.4%) were operated on an emergency basis, in-hospital mortality was 10% (12/120) in elective procedures and 36.5% (23/63) in emergency operations (p <0.0001). Multivariate stepwise logistic regression analysis identified cardiopulmonary by-pass time, emergency operation, arch replacement and the need for femoral vein cannulation at surgery as independent predictors of in- hospital death. Mean follow-up time was 54 ± 30 months (median 50 months), with a Kaplan-Meier survival of 69 ± 4% and of 60 ± 5% at 5 and 7 years, respectively. Cox regression analysis identified arch replacement, perioperative myocardial infarction, preoperative NYHA class, acute type A aortic dissection, the need for femoral vein cannulation at intervention and redo operations as independent predictors of reduced survival at follow-up. When this kind of analysis was performed on hospital survivors only, postoperative tracheostomy, reexploration for bleeding, and the occurrence of postoperative ventricular arrhythmias emerged as risk factors. In conclusion, multiple factors affect both early and long-term outcome following ascending aorta surgery. Preoperative clinical status of patients, priority of surgery and aortic dissection are the main determinants of the short-term results. Otherwise, in hospital survivors, the main determinant for long-term outcome seems to be the immediate postoperative course.

AB - Between 1984 and 1995, 183 patients underwent an ascending aorta procedure at our institution. Their mean age was 60 ± 12.3 years: 116 (63.4%) patients were male, 35 (19. 1%) had a history of congestive heart failure, 72 (39.3%) presented acute type A dissection, 23 (12.6%) were redos and 63 (34.4%) were operated on an emergency basis, in-hospital mortality was 10% (12/120) in elective procedures and 36.5% (23/63) in emergency operations (p <0.0001). Multivariate stepwise logistic regression analysis identified cardiopulmonary by-pass time, emergency operation, arch replacement and the need for femoral vein cannulation at surgery as independent predictors of in- hospital death. Mean follow-up time was 54 ± 30 months (median 50 months), with a Kaplan-Meier survival of 69 ± 4% and of 60 ± 5% at 5 and 7 years, respectively. Cox regression analysis identified arch replacement, perioperative myocardial infarction, preoperative NYHA class, acute type A aortic dissection, the need for femoral vein cannulation at intervention and redo operations as independent predictors of reduced survival at follow-up. When this kind of analysis was performed on hospital survivors only, postoperative tracheostomy, reexploration for bleeding, and the occurrence of postoperative ventricular arrhythmias emerged as risk factors. In conclusion, multiple factors affect both early and long-term outcome following ascending aorta surgery. Preoperative clinical status of patients, priority of surgery and aortic dissection are the main determinants of the short-term results. Otherwise, in hospital survivors, the main determinant for long-term outcome seems to be the immediate postoperative course.

KW - Ascending aorta

KW - Cardiac surgery

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M3 - Articolo

C2 - 9312505

AN - SCOPUS:0030785648

VL - 27

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JO - Giornale Italiano di Cardiologia

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