Abstract 14920: Predictors of Adverse Outcomes Following Elective Ascending Aortic Aneurysm Repair: A Nationwide Cohort Study

Introduction: Elective surgical intervention for ascending aortic aneurysm (AA) is performed when the risk of a future aortic catastrophe outweighs the risk of surgery; however, the data of complication rates following elective repair are limited. Methods: We analyzed adults >18 years of age hospitalized for elective ascending AA surgical intervention in the 2016 and 2017 Nationwide Readmissions Databases. The primary outcome was in-hospital mortality. Secondary outcomes were acute ischemic stroke (AIS), acute myocardial infarction (AMI) and non-elective 30-day readmission. Bayesian lasso probit regression models were used to identify independent predictors of primary and secondary outcomes. Results: Among 4,073 patients hospitalized for elective surgical repair, 28.9% were female. Mean age was 63.0 ± 12.4 years. Concomitant aortic valve surgery was performed in 67%. Overall, 72 (1.8%) died during the initial hospitalization (Figure A). Predictors of in-hospital mortality are shown in Figure B. Of patients alive at discharge, 482 (11.8%) were readmitted within 30 days, with a mortality rate of 2.3% during readmission. Predictors of non-elective 30-day readmission included non-urban localization (Change in probability: 32.5%, 21.7 - 45.7%), chronic liver disease (18.1%, 11.4 - 27.0%), and chronic neurological disorder (15.9%, 12.1 - 20.1%). Main causes of readmissions were arrythmias (20.3%), procedural complications (14.5%), and peri-, endo-, or myocarditis (9.3%). While procedural volume varied between one and 68 procedures / institution, it was not associated with in-hospital mortality, AIS, AMI, or 30-day readmission (p>0.05 for all). Conclusions: One in 25 patients will have a significant complication or die following elective ascending aortic repair and 1 in 8 will be readmitted within 30 days. The risk of surgery compared to the risk of a future aortic catastrophe should be thoroughly assessed prior to recommendation of an ascending AA repair.

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Giant Dissecting Aortic Aneurysm in an Asymptomatic Young Male

Case Reports in Vascular Medicine ◽

10.1155/2015/958464 ◽

2015 ◽

Vol 2015 ◽

pp. 1-2 ◽

Cited By ~ 3

Author(s):

Priyank Shah ◽

Nishant Gupta ◽

Irvin Goldfarb ◽

Fayez Shamoon

Keyword(s):

Aortic Aneurysm ◽

Giant Cell Arteritis ◽

Giant Cell ◽

Hereditary Hemorrhagic Telangiectasia ◽

Surgical Intervention ◽

Young Male ◽

Physical Exam ◽

Ascending Aortic Aneurysm ◽

Rare Finding ◽

Dissecting Aortic Aneurysm

Giant aortic aneurysm is defined as aneurysm in the aorta greater than 10 cm in diameter. It is a rare finding since most patients will present with complications of dissection or rupture before the size of aneurysm reaches that magnitude. Etiological factors include atherosclerosis, Marfan’s syndrome, giant cell arteritis, tuberculosis, syphilis, HIV-associated vasculitis, hereditary hemorrhagic telangiectasia, and medial agenesis. Once diagnosed, prompt surgical intervention is the treatment of choice. Although asymptomatic unruptured giant aortic aneurysm has been reported in the literature, there has not been any case of asymptomatic giant dissecting aortic aneurysm reported in the literature thus far. We report a case of giant dissecting ascending aortic aneurysm in an asymptomatic young male who was referred to our institution for abnormal findings on physical exam.

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Relationship Between Newly Established Perioperative DNR Status and Perioperative Outcomes in the Elderly Population: A NSQIP Database Analysis

Journal of Palliative Care ◽

10.1177/0825859720944746 ◽

2020 ◽

pp. 082585972094474

Author(s):

Ethan Y. Brovman ◽

Mark W. Motejunas ◽

Lauren A. Bonneval ◽

Edward E. Whang ◽

Alan D. Kaye ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Renal Failure ◽

Cardiac Arrest ◽

Surgical Site Infections ◽

Adverse Outcomes ◽

Perioperative Outcomes ◽

Complication Rates ◽

Secondary Outcomes ◽

Tract Infections

Background: Health care practitioners have developed complex algorithms to numerically calculate surgical risk. We examined the association between the initiation of a new do-not-resuscitate (DNR) status during hospitalization and postoperative outcomes, including mortality. We hypothesized that new DNR status would be associated with similar complication rates, even though mortality rates may be higher. Methods: A retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Geriatric Surgery Research File. Two cohorts were defined by the presence of a new DNR status during the hospitalization that was not present on hospital admission. Multivariable logistic regression was used to control for differences between the DNR and non-DNR cohorts. The primary outcome was 30-day mortality. Secondary outcomes included rates of postoperative complications, including returning to the operating room, reintubation, failure to wean from ventilation, surgical site infections, dehiscence, pneumonia, acute kidney injury, renal failure, stroke, cardiac arrest, acute myocardial infarction, transfusion requirements, sepsis, urinary tract infections, venous thromboembolisms, total number of complications for each patient, and hospital length of stay. Results: In our geriatric population with a newly established DNR status, the mortality rate was 39.29%, significantly greater than the non-DNR population after multivariable regression. Secondary outcomes also occurred at an increased rate in the DNR cohort including surgical site infections (8.29% vs 4.04%), pneumonia (18% vs 2.26%), renal insufficiency (2.43% vs 0.35%), acute renal failure (5% vs 0.19%), stroke (3% vs 0.36%), acute myocardial infarction (6.29% vs 0.95%), and cardiac arrest (5.86% vs 0.51%). Conclusions: The initiation of a new DNR status during hospitalization is associated with a significantly higher burden of both morbidity and mortality. This contrasts with prior studies that did not show an increased rate of adverse outcomes and suggests that a new DNR status in postoperative patients may reflect a consequence of adverse postoperative events. The informed consent process in older patients at risk for adverse outcomes after surgery should include discussions regarding goals of care and acceptable risk.

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Ascending aortic aneurysm: propensity score matching analysis of hemiarch and non-hemiarch replacement

Russian Journal of Cardiology ◽

10.15829/1560-4071-2020-3887 ◽

2020 ◽

Vol 25 (10) ◽

pp. 3887

Author(s):

B. N. Kozlov ◽

D. S. Panfilov ◽

E. L. Sonduev ◽

V. L. Lukinov

Keyword(s):

Myocardial Infarction ◽

Aortic Aneurysm ◽

Propensity Score ◽

Hospital Mortality ◽

Propensity Score Matching ◽

Ascending Aortic Aneurysm ◽

Aortic Replacement ◽

Prolonged Ventilation ◽

Ascending Aortic Replacement ◽

Hemiarch Replacement

Aim. To compare the shortand medium-term outcomes of hemiarch and nonhemiarch replacement for ascending aortic aneurysm (AAA).Material and methods. The study included 151 patients with non-syndromic AAA who underwent an elective replacement. Patients were divided into two groups: group 1 (non-hemiarch, n=40) — standard ascending aortic replacement; group 2 (hemiarch, n=111) — ascending aortic replacement with the hemiarch anastomosis in conditions of moderate hypothermia and circulatory arrest with unilateral antegrade cerebral perfusion. To eliminate systematic differences between the compared groups, the propensity score matching (PSM) method was used.Results. Before PSM, there were no significant intergroup differences in the incidence of neurological complications, myocardial infarction, prolonged ventilation, or acute kidney injury. Bleeding-related reoperation rates and hospital mortality significantly differed between groups. After pseudo-randomization between the non-hemiarch and hemiarch groups, there were no significant differences in the incidence of neurological events, myocardial infarction, prolonged ventilation, reoperations for bleeding, acute renal injury, and hospital mortality. Median-term survival and freedom from aortic reoperations also did not show significant intergroup differences.Conclusion. Hemiarch replacement for AAA does not lead to an increase in the incidence of postoperative complications, as well as the risk of shortand mediumterm mortality compared with non-hemiarch.

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Successful surgical intervention to ascending aortic aneurysm with dissection risk in a Patient with Cushing's syndrome and pituitary operation

Journal of Cardiothoracic Surgery ◽

10.1186/1749-8090-10-s1-a229 ◽

2015 ◽

Vol 10 (S1) ◽

Author(s):

Ali Gürbüz ◽

Ufuk Yetkin ◽

Orhan Gökalp ◽

Şahin İşcan ◽

Köksal Dönmez ◽

...

Keyword(s):

Aortic Aneurysm ◽

Cushing’S Syndrome ◽

Surgical Intervention ◽

Cushing's Syndrome ◽

Ascending Aortic Aneurysm

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An unusual combination of persistent silent truncus arteriosus Type-II with ascending aortic aneurysm

Journal of Surgical Case Reports ◽

10.1093/jscr/rjaa216 ◽

2020 ◽

Vol 2020 (7) ◽

Author(s):

Mohamed Farah Yusuf Mohamud ◽

Mohamed Abdullahi Mohamud ◽

Abdinafic Mohamud Hussein ◽

Ismail Gedi İbrahim

Keyword(s):

Aortic Aneurysm ◽

Surgical Intervention ◽

Pulmonary Arteries ◽

Truncus Arteriosus ◽

Cardiac Anomaly ◽

Type Ii ◽

Shortness Of Breath ◽

Ascending Aortic Aneurysm ◽

Congenital Cardiac Anomaly ◽

Vascular Occlusive Disease

Abstract Truncus arteriosus (TA) is a relatively uncommon cyanotic congenital cardiac anomaly accounting for 1.3% of all congenital cardiac malformations. TA associated with an ascending aortic aneurysm is an extremely rare congenital cardiovascular abnormality. A 15-year-old male presented with shortness of breath and cough for 2 weeks. Radiological examinations showed that the ascending aorta and main pulmonary arteries originate from a single truncus with ascending aortic aneurysm. TA has a poor prognosis if remain unrepaired and surgical intervention is necessary to avoid severe pulmonary vascular occlusive disease.

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Glasgow aneurysm scores in patients undergoing open surgical procedure for aortic aneurysm

Vascular ◽

10.1177/1708538114548263 ◽

2014 ◽

Vol 23 (3) ◽

pp. 277-280 ◽

Cited By ~ 1

Author(s):

Anil Ozen ◽

Ertekin Utku Unal ◽

Emre Kubat ◽

Basak Soran Turkcan ◽

Aytac Caliskan ◽

...

Keyword(s):

Aortic Aneurysm ◽

Hospital Mortality ◽

Roc Curve ◽

Surgical Procedure ◽

Roc Curve Analysis ◽

Abdominal Aortic ◽

Elective Repair ◽

Significant Difference ◽

Sensitivity Rate ◽

Open Surgical Procedure

Background To assess the applicability of the Glasgow aneurysm score (GAS) in patients with aortic aneurysm undergoing an elective open surgical procedure in our hospital. Materials and methods A total of 105 patients undergoing elective open surgical procedure between January 2006 and June 2012 were evaluated retrospectively. Glasgow aneurysm score (GAS) was calculated as age+7 points for myocardial disease, +10 points for cerebrovascular disease, and +14 points for renal disease. The best cut-off value for GAS was determined using the ROC curve analysis. Results The hospital mortality rate was 3.8% (4 patients). GAS was significantly lower in patients who survived the operation (76.05 ± 14.71 vs. 92.0 ± 10.8 respectively, p = 0.031). The ICU stay was also significantly lower in patients who survived the operation (2.37 ± 5.23) compared to the nonsurvivors (25.67 ± 13.80, p = 0.001). No significant difference was observed regarding age, duration of hospital stay, and aortic diameter. The area under the ROC curve was 0.818 and for a 100% sensitivity rate, the cut-off value for GAS was 77.5 with a 58.4% specificity rate ( p = 0.031). All patients with a GAS < 77.5 were alive after surgery. Conclusion The GAS appears to be a reliable clinical predictor for in hospital mortality following elective repair of abdominal aortic aneurysm following open surgical procedure.

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Impending rupture of aortic aneurysm eroding skin and sternum: a rare condition

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492319833280 ◽

2019 ◽

Vol 27 (4) ◽

pp. 307-309

Author(s):

Pramote Porapakkham

Keyword(s):

Aortic Aneurysm ◽

Chest Wall ◽

Surgical Intervention ◽

Rare Condition ◽

Anterior Chest Wall ◽

Ascending Aorta ◽

Ascending Aortic Aneurysm ◽

Rare Presentation ◽

Impending Rupture ◽

History Of

A rare presentation of ascending aortic aneurysm eroding into the anterior chest wall and skin is described. Only a few reports of this lethal condition associated with luetic disease have been published previously. A 72-year-old man with a history of blunt chest injury subsequently developed a saccular aneurysm of the ascending aorta protruding out of the anterior chest wall. He was successfully treated with a surgical intervention.

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Open Distal Anastomosis Technique for Ascending Aortic Aneurysm Repair without Cerebral Perfusion

The Heart Surgery Forum ◽

10.1532/hsf.1284 ◽

2015 ◽

Vol 18 (4) ◽

pp. 124

Author(s):

Mehmet Kaplan ◽

Bahar Temur ◽

Tolga Can ◽

Gunseli Abay ◽

Adlan Olsun ◽

...

Keyword(s):

Aortic Aneurysm ◽

Cerebral Perfusion ◽

Circulatory Arrest ◽

Deep Hypothermic Circulatory Arrest ◽

Hypothermic Circulatory Arrest ◽

Distal Anastomosis ◽

Ascending Aortic Aneurysm ◽

Aortic Aneurysm Surgery ◽

Aneurysm Repair ◽

Aortic Aneurysm Repair

Background: This study aimed to report the outcomes of patients who underwent proximal thoracic aortic aneurysm surgery with open distal anastomosis technique but without cerebral perfusion, instead under deep hypothermic circulatory arrest.Methods: Thirty patients (21 male, 9 female) who underwent ascending aortic aneurysm repair with open distal anastomosis technique were included. The average age was 60.2±11.7 years. Operations were performed under deep hypothermic circulatory arrest and the cannulation for cardiopulmonary bypass was first done over the aneurysmatic segment and then moved over the graft. Intraoperative and early postoperative mortality and morbidity outcomes were reported.Results: Average duration of cardiopulmonary bypass and cross-clamps were 210.8±43 and 154.9±35.4 minutes, respectively. Average duration of total circulatory arrest was 25.2±2.4 minutes. There was one hospital death (3.3%) due to chronic obstructive pulmonary disease at postoperative day 22. No neurological dysfunction was observed during the postoperative period.Conclusion: These results demonstrate that open distal anastomosis under less than 30 minutes of deep hypothermic circulatory arrest without antegrade or retrograde cerebral perfusion and cannulation of the aneurysmatic segment is a safe and reliable procedure in patients undergoing proximal thoracic aortic aneurysm surgery.

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Epigenetic Profiling Identifies Novel Genes for Ascending Aortic Aneurysm Formation with Bicuspid Aortic Valves

The Heart Surgery Forum ◽

10.1532/hsf.1247 ◽

2015 ◽

Vol 18 (4) ◽

pp. 134 ◽

Cited By ~ 12

Author(s):

Asad A Shah

Keyword(s):

Gene Expression ◽

Aortic Aneurysm ◽

Methylation Status ◽

Aortic Aneurysms ◽

Aortic Valves ◽

Ascending Aortic Aneurysm ◽

Novel Genes ◽

Aneurysm Formation ◽

Aortic Replacement ◽

Bicuspid Aortic Valves

Background: Bicuspid aortic valves predispose to ascending aortic aneurysms, but the mechanisms underlying this aortopathy remain incompletely characterized. We sought to identify epigenetic pathways predisposing to aneurysm formation in bicuspid patients.Methods: Ascending aortic aneurysm tissue samples were collected at the time of aortic replacement in subjects with bicuspid and trileaflet aortic valves. Genome-wide DNA methylation status was determined on DNA from tissue using the Illumina 450K methylation chip, and gene expression was profiled on the same samples using Illumina Whole-Genome DASL arrays. Gene methylation and expression were compared between bicuspid and trileaflet individuals using an unadjusted Wilcoxon rank sum test. Results: Twenty-seven probes in 9 genes showed significant differential methylation and expression (P<5.5x10-4). The top gene was protein tyrosine phosphatase, non-receptor type 22 (PTPN22), which was hypermethylated (delta beta range: +15.4 to +16.0%) and underexpressed (log 2 gene expression intensity: bicuspid 5.1 vs. trileaflet 7.9, P=2x10-5) in bicuspid patients, as compared to tricuspid patients. Numerous genes involved in cardiovascular development were also differentially methylated, but not differentially expressed, including ACTA2 (4 probes, delta beta range: -10.0 to -22.9%), which when mutated causes the syndrome of familial thoracic aortic aneurysms and dissectionsConclusions: Using an integrated, unbiased genomic approach, we have identified novel genes associated with ascending aortic aneurysms in patients with bicuspid aortic valves, modulated through epigenetic mechanisms. The top gene was PTPN22, which is involved in T-cell receptor signaling and associated with various immune disorders. These differences highlight novel potential mechanisms of aneurysm development in the bicuspid population.

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