Hirokazu Fujimoto, MD, PhD, Meghana R. K

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Presentation transcript:

Influence of aortitis on late outcomes after repair of ascending aortic aneurysms Hirokazu Fujimoto, MD, PhD, Meghana R.K. Helder, MD, Alberto Pochettino, MD, Kevin L. Greason, MD, Rakesh M. Suri, MD, Richard C. Daly, MD, Joseph A. Dearani, MD, Joseph J. Maleszewski, MD, Zhuo Li, MS, Hartzell V. Schaff, MD The Journal of Thoracic and Cardiovascular Surgery Volume 150, Issue 3, Pages 589-594 (September 2015) DOI: 10.1016/j.jtcvs.2015.06.027 Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Patient selection and stratification. The Journal of Thoracic and Cardiovascular Surgery 2015 150, 589-594DOI: (10.1016/j.jtcvs.2015.06.027) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Aortic pathology: A, Aortic atherosclerosis is characterized by intimal plaques containing cholesterol clefts and foam cells. The subjacent media show mild, secondary, degenerative changes. B, Medial degeneration is characterized by elastic membrane fragmentation and mucopolysaccharide deposition throughout the media. C, Giant cell aortitis is characterized by medial inflammation with multinucleated giant cells imparting a moth-eaten appearance to the aortic media (top panels: hematoxylin-eosin; bottom panels: Verhoeff-van Gieson; original magnification ×40 for all). The Journal of Thoracic and Cardiovascular Surgery 2015 150, 589-594DOI: (10.1016/j.jtcvs.2015.06.027) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Risk of aortic reoperation: Cumulative risk of aortic reoperation at 5 years was 13% for patients with aortitis; 6% for patients with medial degeneration; and 9% for patients with atherosclerosis; for the respective groups, the 10-year cumulative risk of aortic reoperation was 21% (95% CI: 11%-30%); 11% (95% CI: 5%-16%); and 19% (95% CI: 11%-27%) (P = .025). The Journal of Thoracic and Cardiovascular Surgery 2015 150, 589-594DOI: (10.1016/j.jtcvs.2015.06.027) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Operative mortality: Risk of death for repair of ascending aortic aneurysm (within 30 days postoperatively) varied by decade of operation. Mortality was 10% before 1990; 9% between 1990 and 1999; 3% between 2000 and 2009; and 2% during and after 2010. Sample sizes are shown as number of patients (number of events). Error bars indicate 95% CIs. The Journal of Thoracic and Cardiovascular Surgery 2015 150, 589-594DOI: (10.1016/j.jtcvs.2015.06.027) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Overall survival differed significantly among the groups. At 5 years, survival was 72% for patients with aortitis, 84% for patients with medial degeneration, and 74% for patients with atherosclerosis; for the respective groups, 10-year survival was 45% (95% CI: 36%-57%); 66% (95% CI: 59%-73%); and 45% (95% CI: 37%-54%) (P < .001). The Journal of Thoracic and Cardiovascular Surgery 2015 150, 589-594DOI: (10.1016/j.jtcvs.2015.06.027) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Overall survival differed significantly between groups. The Journal of Thoracic and Cardiovascular Surgery 2015 150, 589-594DOI: (10.1016/j.jtcvs.2015.06.027) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions