Statin Therapy in Patients Undergoing Thoracic Aorta Replacement for Aortic Aneurysms

Abstract Background Patients undergoing surgery for thoracic aortic aneurysms receive statin therapy out of proportion to cardiovascular comorbidity. We sought to determine the prevalence of statin use among patients presenting for thoracic aortic aneurysm surgery and investigate its effect on outcomes. Methods From January 1, 2005 to January 1, 2011, 1,839 consecutive patients underwent aortic replacement for degenerative thoracic aortic aneurysm at Cleveland Clinic. Of these, 771 (42%) were on statins preoperatively. Statin users (vs. nonstatin users) were older (65 ± 11 vs. 56 ± 16 years) and had more hypertension (78 vs. 59%). Propensity matching based on 56 preoperative variables other than lipid levels was used to compare outcomes among 570 matched patient pairs (74% of possible pairs). Results Propensity-matched statin and nonstatin users were aged 64 ± 11 years, 394 (69%) versus 387 (68%) were male, and 437 (77%) versus 442 (78%) had ascending aortic aneurysms, respectively. Overall, 25% of patients were followed for more than 8.2 years and 10% for more than 10 years. Perioperative outcomes were similar, including hospital mortality (11 [1.9%] vs. 5 [0.88%]) and stroke (22 [3.9%] vs. 13 [2.3%]), but 16 statin users (2.8%) versus 5 nonstatin users (0.88%) required temporary dialysis after surgery (p = 0.02). At 6 years, 3.7% of statin users versus 5.1% of nonstatin users (p[log-rank] = 0.5) underwent further aortic surgery, and at 10 years, mortality was 25% in both groups (p > 0.5). Conclusion Patients presenting for thoracic aortic aneurysm surgery frequently receive unnecessary statins. Additionally, statin use was associated with more postoperative renal failure, but not less intermediate-term risk for aortic reintervention or all-cause mortality after surgery. Therefore, presence of a thoracic aortic aneurysm should not be considered an indication for statin therapy in the absence of well-established indications.

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International study on impact of COVID‐19 on cardiac and thoracic aortic aneurysm surgery

Journal of Cardiac Surgery ◽

10.1111/jocs.14910 ◽

2020 ◽

Author(s):

Mohammed Idhrees ◽

Mohamad Bashir ◽

Mostafa Mousavizadeh ◽

Saeid Hosseini

Keyword(s):

Aortic Aneurysm ◽

Thoracic Aortic Aneurysm ◽

International Study ◽

Aneurysm Surgery ◽

Aortic Aneurysm Surgery

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Changes in Cerebrospinal Fluid Pressure and Lactate Concentrations during Thoracoabdominal Aortic Aneurysm Surgery

Anesthesiology ◽

10.1097/00000542-199701000-00007 ◽

1997 ◽

Vol 86 (1) ◽

pp. 41-47 ◽

Cited By ~ 42

Author(s):

Benjamin Drenger ◽

Stephen D. Parker ◽

Steven M. Frank ◽

Charles Beattie

Keyword(s):

Spinal Cord ◽

Cerebrospinal Fluid ◽

Aortic Aneurysm ◽

Aortic Surgery ◽

Thoracoabdominal Aortic Aneurysm ◽

Aortic Occlusion ◽

Aneurysm Surgery ◽

Csf Pressure ◽

Csf Lactate ◽

Aortic Aneurysm Surgery

Background Although ischemic injury to the spinal cord is a well-known complication of aortic surgery, no metabolic markers have been identified as predictors of an adverse outcome. This study evaluated the effect of cerebrospinal fluid (CSF) drainage, with and without distal femoral perfusion or moderate hypothermia on blood and CSF lactate concentrations and CSF pressure during thoracoabdominal aortic aneurysm surgery. Methods Three nonconcurrent groups of patients were studied prospectively: patients with normal body temperature (35 degrees C) but without distal femoral bypass (n = 6), patients with normal body temperature with bypass (n = 7), and patients with hypothermia (30 degrees C) and bypass (n = 8). In all patients, CSF pressure was recorded before, during, and after aortic cross-clamping. During the surgical repair, CSF drainage was performed using a 4-Fr intrathecal silicone catheter. Blood and CSF lactate concentrations were measured throughout the operation. Results Significant increases in blood (490%) and CSF (173%) lactate concentrations were observed during and after thoracic aortic occlusion in patients with normothermia and no bypass (P < 0.02 and 0.05, respectively). Distal perfusion attenuated the increase in both blood and CSF lactate (P < 0.01), and a further reduction was achieved with hypothermia of 30 degrees C (P < 0.001). Patients who became paraplegic showed a greater increase in CSF lactate concentrations after aortic clamp release compared with those who suffered no neurological damage (275% vs. 123% of baseline; P < 0.05). Increased CSF pressure of 42-60% (P < 0.005) was noted soon after thoracic aortic occlusion, both with and without distal femoral bypass. Conclusions Incremental reductions in CSF lactate concentrations were achieved using distal femoral bypass and hypothermia. The reduction in CSF lactate correlated with the methods used to protect the spinal cord during thoracoabdominal aortic aneurysm surgery and was associated with better outcome. Decompression by distal bypass of the hemodynamic overload caused by aortic occlusion was insufficient to eliminate the acute increase in CSF pressure. Cerebrospinal fluid lactate measurements during high aortic surgery may accurately represent the spinal cord metabolic balance.

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Thoracoabdominal and descending thoracic aortic aneurysm surgery in patients aged 79 years or older

Journal of Vascular Surgery ◽

10.1067/mva.2002.127348 ◽

2002 ◽

Vol 36 (3) ◽

pp. 469-475 ◽

Cited By ~ 53

Author(s):

Tam T.T. Huynh ◽

Charles C. Miller ◽

Anthony L. Estrera ◽

Eyal E. Porat ◽

Hazim J. Safi

Keyword(s):

Aortic Aneurysm ◽

Thoracic Aortic Aneurysm ◽

Aneurysm Surgery ◽

Descending Thoracic Aortic Aneurysm ◽

Aortic Aneurysm Surgery

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Decision-Making in Thoracic Aortic Aneurysm Surgery—Clinician and Patient View

Seminars in Thoracic and Cardiovascular Surgery ◽

10.1053/j.semtcvs.2019.05.032 ◽

2019 ◽

Vol 31 (4) ◽

pp. 638-642

Author(s):

Arjen L. Gökalp ◽

Johanna J.M. Takkenberg

Keyword(s):

Decision Making ◽

Aortic Aneurysm ◽

Thoracic Aortic Aneurysm ◽

Aneurysm Surgery ◽

Aortic Aneurysm Surgery

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Bicarbonates for the Prevention of Postoperative Renal Failure in Endovascular Aortic Aneurysm Repair: A Randomized Pilot Trial

Anesthesiology Research and Practice ◽

10.1155/2013/467326 ◽

2013 ◽

Vol 2013 ◽

pp. 1-8

Author(s):

Véronique Brulotte ◽

François A. Leblond ◽

Stéphane Elkouri ◽

Éric Thérasse ◽

Vincent Pichette ◽

...

Keyword(s):

Aortic Aneurysm ◽

Renal Injury ◽

Aortic Surgery ◽

Pilot Trial ◽

Kidney Injury ◽

Aneurysm Surgery ◽

Neutrophil Gelatinase Associated Lipocalin ◽

Group B ◽

Kidney Injury Molecule 1 ◽

Aortic Aneurysm Surgery

Purpose.Contrast-induced nephropathy (CIN) can contribute to acute kidney injury (AKI) in patients undergoing endovascular aortic aneurysm surgery. We evaluated the incidence of AKI together with the evolution of early biomarkers of renal injury in patients receiving bicarbonates or NaCl 0.9%.Methods.This study involved endovascular aortic aneurysm surgery patients. Group A (n=17) received bicarbonates 3 mL/kg/h for 1 h before the procedure and then 1 mL/kg/h until 6 h after surgery, whereas group B (n=17) received NaCl 0.9% using the same protocol. Biomarkers of renal injury from urine (interleukin-18 (IL-18), neutrophil gelatinase-associated lipocalin (NGAL), N-acetyl-β-D-glucosaminidase (NAG), and kidney injury molecule 1 (KIM-1)) and blood (NGAL, cystatin C) were measured at baseline and 3, 24, and 48 h postoperatively.Results.AKI occurred in 1 patient (2.9%), in the bicarbonates group. IL-18, NAG, NGAL, and KIM-1 significantly rose in both groups after the surgery. There was a greater rise in NGAL and IL-18 after 3 h in the bicarbonates versus NaCl 0.9% group: 1115% versus 240% increase (P=0.03) and 338% increase versus 1.4% decrease (P=0.01).Conclusions.Despite significant elevation in biomarkers of renal injury, we demonstrated a low rate of AKI following endovascular aortic surgery.

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Protocol for a randomised controlled trial for Treatment in Thoracic Aortic Aneurysm: Surgery versus Surveillance (TITAN: SvS)

BMJ Open ◽

10.1136/bmjopen-2021-052070 ◽

2021 ◽

Vol 11 (5) ◽

pp. e052070

Author(s):

Ming Hao Guo ◽

Jehangir J Appoo ◽

George A Wells ◽

Michael Chu ◽

Maral Ouzounian ◽

...

Keyword(s):

Randomised Controlled Trial ◽

Aortic Aneurysm ◽

Research Ethics ◽

Thoracic Aortic Aneurysm ◽

Controlled Trial ◽

Health Science ◽

Aneurysm Surgery ◽

Research Ethics Board ◽

Randomised Controlled ◽

Aortic Aneurysm Surgery

IntroductionAscending thoracic aortic aneurysm (ATAA) is an asymptomatic condition that can lead to catastrophic events of rupture or dissection. Current guidelines are based on limited retrospective data and recommend surgical intervention for ATAA with a diameter of greater or equal to 5.5 cm. Treatment in Thoracic Aortic Aneurysm: Surgery versus Surveillance is the first prospective, multicentre, randomised controlled trial that compares outcomes of patients undergoing early elective ascending aortic surgery to patients undergoing medical surveillance.Methods and analysisPatients between the ages of 18 and 80 with an asymptomatic ATAA between 5.0 cm and 5.4 cm in diameter are eligible for randomisation to early surgery or surveillance. Patients in the surgery group will be followed at 1 month after discharge, then annually for a minimum of 2 years and up to 5 years. Patients in the surveillance group will be followed annually from their index clinic visit for a minimum of 2 years and up to 5 years. The primary outcome is all-cause mortality at follow-up. A sample size of 618 subjects (309 in each group) will achieve an 80% power at a 0.047 significance level.Ethics and disseminationThis study has received Ottawa Health Science Network Research Ethics Board approval (Protocol 20180007-01H), which was most recently updated on 25 November 2020. The Research Ethics Board have granted approval to the study at 14 participating institutions, including the Ottawa Health Science Network Research Ethics Board. On completion of data analysis, the result of the trial will be presented at national and international conferences, and published in relevant journals, regardless of the finding of the trial.Trial registration numberNCT03536312.

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Application and Limitation of Somatosensory Evoked Potential Monitoring during Thoracic Aortic Aneurysm Surgery

Anesthesiology ◽

10.1097/00000542-198512000-00027 ◽

1985 ◽

Vol 63 (6) ◽

pp. 700-702 ◽

Cited By ~ 35

Author(s):

OSAMU TAKAKI ◽

FUKUICHIRO OKUMURA

Keyword(s):

Aortic Aneurysm ◽

Thoracic Aortic Aneurysm ◽

Evoked Potential ◽

Somatosensory Evoked Potential ◽

Aneurysm Surgery ◽

Evoked Potential Monitoring ◽

Aortic Aneurysm Surgery ◽

Potential Monitoring

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A systematic review of postoperative cognitive decline following open and endovascular aortic aneurysm surgery

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2016.0338 ◽

2017 ◽

Vol 99 (2) ◽

pp. 97-100 ◽

Cited By ~ 9

Author(s):

RA Benson ◽

BA Ozdemir ◽

D Matthews ◽

IM Loftus

Keyword(s):

Systematic Review ◽

Aortic Aneurysm ◽

Cognitive Decline ◽

Aortic Surgery ◽

Cognitive Test ◽

Future Research ◽

Aneurysm Surgery ◽

Thoracic Aortic Surgery ◽

Postoperative Cognitive Decline ◽

Aortic Aneurysm Surgery

OBJECTIVES Postoperative cognitive decline (POCD) is a well-recognised neurological phenomenon following major surgery. Most commonly seen in elderly patients, it has direct links to increased long-term morbidity and reduced quality of life. Its incidence following open and endovascular abdominal and thoracic aneurysm surgery is unclear. The purpose of this systematic review is to collate available evidence for POCD following abdominal and thoracic aortic surgery, and to identify continuing controversies directing future research. METHODS A MEDLINE search was conducted following the recommendations of the PRISMA guidelines. Terms searched for included but were not limited to: aortic surgery, delirium, postoperative cognitive decline/dysfunction thoracic aortic surgery, abdominal aortic surgery. Reference lists were searched for additional studies. RESULTS Five observational studies were identified from the literature search. Variation in study methods, cognitive test batteries and thresholds set by the study coordinators did not allow for pooled results. In those studies that did find evidence of decline, risk was linked to age over 65 years, presence of postoperative delirium and decreased years in education. CONCLUSIONS Evidence thus far suggests that POCD can affect patients following major aortic, non-cardiothoracic as well as cardiothoracic surgery. Future research should focus on using a validated repeatable battery of cognitive tests and a single defined threshold for POCD to allow pooled analysis and more robust conclusions. Larger, adequately powered studies are required to re-evaluate the effect of aortic aneurysm surgery on postoperative cognitive function.

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