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Original Articles: Adult Cardiac

Current Role and Outcomes of Ascending Aortic Replacement for Severe Nonaneurysmal Aortic Atherosclerosis

Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy

Accepted for publication November 11, 2009.

^_* Address correspondence to Dr Zingone, 22 vicolo Scaglioni, 34141 Trieste, Italy (Email: bartolo.zingone{at}gmail.com).

Background: Severe atherosclerosis of the ascending aorta is a challenging issue potentially affecting indications for surgery, operative choices, and patients' outcome. No standard treatment has emerged to date, and uncertainties persist about criteria for selecting patients and procedures.

Methods: Replacement of the atherosclerotic ascending aorta was performed in 64 patients at time of either aortic (n = 49), mitral (n = 21), or tricuspid (n = 7) valve surgery. Coronary artery bypass grafting was performed in 53 patients, and the majority of patients underwent combined procedures (n = 49). Mean age was 72.0 ± 7.6 years. The expected operative mortality, by logistic European System for Cardiac Operative Risk Evaluation, was 29.0% accounting for ascending aortic replacement and 13.1% disregarding it. Circulatory arrest under deep hypothermia, eventually combined with either retrograde or antegrade brain perfusion, was required in 61 cases.

Results: Early death, stroke, and myocardial infarction rates were 10.9%, 6.3%, and 7.8%, respectively. Factors univariately associated with early deaths were preoperative renal failure requiring dialysis (p = 0.001) and longer cardiopulmonary bypass (p = 0.001) and cardioplegia (p = 0.008) times. Cumulative survival at 1, 3, and 5 years was 86% ± 4%, 74% ± 6%, and 68% ± 8%, respectively.

Conclusions: Replacement of the atherosclerotic ascending aorta can be carried out at acceptable mortality rates despite the high rates of preoperative comorbidity and the significant incidence of postoperative complications.

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