Composite grafts were constructed during surgery by sewing a Bjork-Shiley or a bileaflet valve in a Dacron tube graft. Results: Median survival of all patients was 13.1 years in group A and 20.1 years in group B. One patient, presenting with acute dissection, suffered from redissection with ischemia of the mesenteric vessels 2 days after graft replacement and 2 other patients died from multiorgan failure. Another late death resulted from cerebral hemorrhage 14 years after aortic surgery. Epub 2016 Jul 26. Crawford and coworkers demonstrated that 70% of surviving patients with DeBakey type I dissection were free from aortic reoperation for aneurysmal dilation of the distal false channel, but none out of 9 patients with an intimal tear in the transverse arch, which was included in the resection, required reoperation [27]. Controlled hypotension versus normotensive resuscitation strategy for people with ruptured abdominal aortic aneurysm. Hollier LH, Plate G, O'Brien PC, Kazmier FJ, Gloviczki P, Pairolero PC, Cherry KJ. The freedom from reoperation was 65±11% at 5 years, 49±13% at 10, and 25±19% at 14 years in group A, and 91±2% at 5, 82±3% at 10, and 79±4% at 15 years in group B (P≪0.001; Fig. According to the observation that β-blockers may reduce the progression of aortic dilatation, all patients with MfS should receive prophylactic β-adrenergic blockade. In conclusion, the surgical treatment of aneurysms of the thoracic aorta in MfS-patients is associated with a considerably higher risk of redissection and recurrent aneurysm compared to other etiologies of aortic disease. Between March 1975 and August 1994, 331 patients were operated on for aneurysms or dissections of the thoracic aorta at the Department of Cardiac Surgery at the University Hospital Großhadern, Munich, Germany. [Medline] . In one patient, vascular graft replacement was combined with valve resuspension. A retrospective review of 96 patients who underwent repair of a ruptured abdominal aortic aneurysm was performed to determine whether these factors would necessarily be applicable to all populations. Researchers found no significant differences in … The dilatation affects all three layers of the arterial wall. We recorded 7 (25%, group A) versus 35 (14.2%, group B) late deaths among the 28 versus 247 early survivors. USA.gov. The in-hospital mortality rate was 60.4%, with a 30-day mortality rate of 56.3%. In order to reduce the high reoperation rate in MfS patients, frequent clinical follow-up may contribute to improve life expectancy in MfS patients. Over the past 4 years, in cases of acute type I or II dissections, we preferred an open distal anastomosis without cross-clamping of the aorta. Long-term survival and HrQoL were similar for patients with a repaired ruptured or symptomatic aneurysm and … References 1. Svensson recommended an intervention as soon as the aorta reaches twice the diameter as the unaffected distal part of the aorta [24]. Three of the 8 patients underwent reoperation after Wheat procedure because of sinus valsalva aneurysm. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Complications such as renal failure, infection, and stroke were also far below the Clipboard, Search History, and several other advanced features are temporarily unavailable. An abdominal aortic aneurysm is an aneurysm (blood vessel rupture) in the part of the aorta that passes through the belly (abdomen). Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. MfS is caused by abnormalities in the production of fibrillin, a 350 kD glycoprotein, which represents the major structural component of connective tissue microfibrils [2]. The mean age at the time of first surgical intervention in MfS was 34.2±9 years (range 19–54), which is significantly lower compared to not MfS related cases with a mean age of 54±13 years (range 9–76; P=0.0001). aortic sizes greater than 4 cm, 5 cm, or 6 cm, is 5.3%, 6.5%, and 14.1%, respectively [2]. Eliason: Patients considered good surgical candidates are those who are able to perform normal daily activities independently and are either never smokers or quit cigarettes a long time ago. Two MfS patients died in the operation room of uncontrollable bleeding due to the fragile aortic tissue. And if surgical repair is advised, don’t put it off. Would you like email updates of new search results? Five MfS patients (15.2%) and 50 patients (16.8%) of group B presented with aortic arch involvement. The present study demonstrates that reoperation and recidives were considerably more frequent in MfS compared to patients with non-fibrillinopathic etiologies of aortic disease. Some studies have suggested restricting patient selection for repair on the basis of certain preoperative factors including age, increased creatinine level, low hemoglobin level, loss of consciousness, electrocardiographic changes, and preoperative cormorbid medical conditions. After a rupture of an abdominal aorta aneurysm the risk of death is approximately 80%. Up to now, more than 70 mutations in the FBN 1 gene have been described in association with MfS. Another MfS patient, whose aortic arch was replaced 3 years after replacement of the ascending aorta, developed progressive aneurysmal dilatation of the descending aorta from 4 to 7.2 cm in diameter within 6 months, leading to a second reoperation. [Survival rate of patients with ascending aorta aneurysm and aortic valve regurgitation in the late postoperative period]. Late survival after abdominal aortic aneurysm repair: influence of coronary artery disease. In group B, the majority of patients underwent Wheat’s operation (Table 2 ). Various causes of death were observed in group B, most of the patients suffered from deteriorating organ function. Among patients requiring emergency aortic arch surgery, our program had a 4.7% mortality rate compared to 10.9% mortality across the country. 2014 May 19;1(4):207-213. doi: 10.1002/ams2.42. Nine MfS patients (27.3%) underwent more than one reoperation. Pneumomediastinum in COVID-19 patients: a case series of a rare complication, 2019 EACTS/EACTA/EBCP guidelines on cardiopulmonary bypass in adult cardiac surgery, Current options and recommendations for the use of thoracic endovascular aortic repair in acute and chronic thoracic aortic disease: an expert consensus document of the European Society for Cardiology (ESC) Working Group of Cardiovascular Surgery, the ESC Working Group on Aorta and Peripheral Vascular Diseases, the European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the ESC and the European Association for Cardio-Thoracic Surgery (EACTS), 2020 EACTS/ELSO/STS/AATS expert consensus on post-cardiotomy extracorporeal life support in adult patients, 2019 EACTS Expert Consensus on long-term mechanical circulatory support, About European Journal of Cardio-Thoracic Surgery, About the European Association for Cardio-Thoracic Surgery, About the European Society of Thoracic Surgeons, https://doi.org/10.1016/S1010-7940(98)00043-8, Receive exclusive offers and updates from Oxford Academic, Secondary surgical interventions after endovascular stent-grafting of the thoracic aorta, Clinical outcomes of combined aortic root reimplantation technique and total arch replacement, Inherited diseases and syndromes leading to aortic aneurysms and dissections, Contemporary results of hemiarch replacement, Copyright © 2021 European Association for Cardio-Thoracic Surgery. Information concerning aortic dissection or dilatation was obtained from preoperative and postoperative aortic imaging studies. In group B 26.5% were categorized as type I, 21.5% as type II and 2.7% as type III dissections. 2011 Dec;23(4):274-9. doi: 10.1177/1531003511408737. 4 ). In 5 patients (15.2%), surgery was extended into the aortic arch, utilizing deep hypothermic circulatory arrest as described above. Results: The mean age of the patients was 73 years. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. The location of a thoracic aneurysm determines many factors, including where the incision for surgery … Due to the progress of the dissection or aneurysmal dilatation, which is frequently associated with aortic rupture, the late mortality in these patients is high, even after surgical treatment of aortic dissection [12]. This test is most commonly used to diagnose abdominal aortic aneurysms. These data were expressed as the mean±S.E. Variables evaluated were patient age, sex, NYHA class, study group (Marfan patients versus non Marfan patients), time of operation, type of dissection (DeBakey I,II or III, acute or chronic dissection or chronic aneurysm), different aortic locations, emergency operation, cardiac tamponade, bypass time, different methods of myocardial protection, operative techniques (composite graft versus non-composite graft surgery), arch replacement, aortic valve regurgitation, additional coronary artery disease, reoperations and recidives. During the past 20 years, three different methods of myocardial protection were employed: Between 1975 and 1977, induced ventricular fibrillation with moderate systemic hypothermia (26–28°C) was used. When there is no treatment for patients who are suffering from an aneurysm that is 5 centimeters above, the survival rate is only 20%. A false aneurysm (pseudoaneurysm) is caused by blood leaking through the arterial wall but contained by the adventitia o… Out of the 33 patients with MfS, 23 were male and 10 female. There was no difference in gender distribution between MfS patients and not MfS related patients (220 male and 78 female). All patients, who received aortic valve replacement or a composite aortic graft with mechanical prostheses were continued on anticoagulation with phenprocoumon (Marcumar®). Methods: The preoperative New York Heart Association (NYHA) functional class was 3.4±0.8 in A and 3.1±0.9 in B. 2018 Jan. 67 (1):2-77.e2. also succeeded in improving long-term results in 100 MfS-patients, even considering the fact that in this study, only 7 patients suffered from acute dissection. A total of 22 MfS patients had to undergo surgery due to acute (57.6%) or chronic (9.1%) aortic dissections. Abdominal aortic aneurysms are fairly common and can be life-threatening if not treated immediately. The causes of late death are shown in Table 4 . Christian Detter, Helmut Mair, Hanns-Georg Klein, Carmina Georgescu, Armin Welz, Bruno Reichart, Long-term prognosis of surgically-treated aortic aneurysms and dissections in patients with and without Marfan syndrome, European Journal of Cardio-Thoracic Surgery, Volume 13, Issue 4, April 1998, Pages 416–423, https://doi.org/10.1016/S1010-7940(98)00043-8. The Johns Hopkins group has suggested 6 cm as a cut-off for elective replacement of the ascending aorta [19],[20], presenting excellent long-term results by using composite graft repair for MfS-related aneurysms of the ascending aorta. doi: 10.1002/14651858.CD011664.pub2. 2016 May 13;(5):CD011664. Garland BT, Danaher PJ, Desikan S, Tran NT, Quiroga E, Singh N, Starnes BW. The influence of aortic dissection on overall survival showed a significantly lower survival for acute or chronic dissection compared to aneurysms and was lowest in acute dissection (P≪0.001, Fig. If the ascending aorta has to be replaced, we recommend the composite graft technique and a more aggressive approach to reduce the prevalence of distal reoperations. 2019 Aug 6;12(3):118. doi: 10.3390/ph12030118. A total of 78.8% of MfS patients and 54.4% of group B patients presented with moderate or severe concomitant aortic valve regurgitation. In contrast, Pyeritz demonstrated that even in aortas with a diameter of less than 5 cm, dissections may occur [25]. Abdominal aortic aneurysms are often found during an examination for another reason or during routine medical tests, such as an ultrasound of the heart or abdomen.To diagnose an abdominal aortic aneurysm, doctors will review your medical and family history and do a physical exam. Localized aneurysms of the ascending aorta were removed on cardiopulmonary bypass and moderate hypothermia (26–28°C). Further cardiac reinterventions are listed in Table 5. Thus, we now use the technique of deep hypothermia and circulatory arrest for an open distal anastomosis in MfS patients with acute dissection of the ascending aorta, regardless if there is an involvement of the aortic arch or not. NLM What is the Survival Rate Of An Aortic Dissection? Of these, 17 reoperations were due to recidives. The primary objective of this review was to assess the perioperative mortality and operative time of laparoscopic (total and hand-assisted) surgical repair of abdominal aortic aneurysms (AAA) compared to traditional open surgical repair or EVAR. Alonso-Pérez M, Segura RJ, Sánchez J, Sicard G, Barreiro A, García M, Díaz P, Barral X, Cairols MA, Hernández E, Moreira A, Bonamigo TP, Llagostera S, Matas M, Allegue N, Krämer AH, Mertens R, Coruña A. Ann Vasc Surg. [Article in Lithuanian] Cypiene R(1), Grebelis A, Semeniene P, Zakarkaite D, Nogiene G, Uzdavinys G, Sirvydis V. The type of primary operation (composite graft versus other procedures) showed a significant influence on late and overall survival (P≪0.05; Fig. Numata S, Yamazaki S, Tsutsumi Y, Ohashi H. Interact Cardiovasc Thorac Surg. Epub 2019 Mar 21. On a multivariate analysis, preoperative factors of loss of consciousness, a lowest preoperative systolic blood pressure less than 90 mm Hg, a hemoglobin level less than 10 g/dl, and a creatinine level greater than 1.5 mg/dl were predictive of death. Oxford University Press is a department of the University of Oxford. Considering the very high reoperation rate in our MfS patients and the rapid development and progression of aneurysmal dilatation, we require clinical follow-up by monitoring of the entire aorta at least twice a year. Growth rate of >0.5 cm/y when the ascending aorta is <5.0 cm in diameter. In patients who had the sets of preoperative factors that were associated with a 100% mortality rate, there were intraoprative factors that influenced their death. Epub 2011 Aug 1. When and how to include arch repair in patients with acute dissections involving the ascending aorta, Marfan’s Syndrome: natural history and long-term follow-up of cardiovascular involvement, Eleven-year experience with composite graft replacement of the ascending aorta and aortic valve, Surgical treatment of aneurysm and/or dissection of the ascending aorta, transverse aortic arch, and ascending aorta and transverse aortic arch. Ruptured and dissected aneurysms are medical emergencies that can have fatal consequences. Since aortic dissection occurs in aortic dilatation, it seems reasonable to replace a dilated aorta as early as possible. Patients who have a ruptured abdominal aortic aneurysm should not be denied therapy on the basis of any specific set of preoperative factors. Factors increasing the mortality rate for patients with ruptured abdominal aortic aneurysms. Applying this technique, the aortic arch can be examined for additional intimal tears in order to include that part of the vessel in the resection. Most patients die before reaching hospital, but if the surgery is successful, the survival rate can reach 50%. One patient in group A received a coronary artery bypass graft, 2 patients a mitral valve replacement. A more radical operation may therefore reduce the high rate of aortic recidives as well as the need for distal reoperations and lead to a decrease in late deaths [21],[22],[23],[24],[26],[27],[28]. Ten years after open AAA repair, the overall survival rate was 59 %. Maguire EM, Pearce SWA, Xiao R, Oo AY, Xiao Q. The clinical phenotype based on standard diagnostic criteria [13] and pedigree analysis were applied to identify 33 patients with classical features of MfS (group A). Results: We observed 7 (25.0%, A) versus 35 (14.2%, B) late deaths among the 28 (A) versus 247 (B) early survivors. Long-term survival and complications after aortic aneurysm repair, Marfan Syndrome: the variability and outcome of operative management, Cardiovascular screening in Marfan’s syndrome, Indipendent determinants of operative mortality for patients with aortic dissections. Methods: From March 1975 to August 1994, 33 patients with classic MfS (group A, age 34.2±9 years) and 298 patients with non-fibrillinopathic aortic disease (group B, age 54±13 years) underwent aortic surgery. All patients with acute dissections were classified as NYHA III or IV. Without surgical repair, the annual survival rate is only about 20%. Further studies should be directed to optimizing preoperative resuscitation. Thus, MfS was not a risk factor for early mortality. The in-hospital mortality rate was 60.4%, with a 30-day mortality rate of 56.3%. 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Or the aneurysm repair 1997 in order to reduce the progression of aortic.. Practice guidelines on the care of patients with aortic aneurysm never undergo surgery but are monitored on a basis. A regular basis as a precaution to measure any growth hypothermic circulatory arrest as described above function... Has reached or exceeded 4 cm, dissections may occur [ 25 ] the entire aorta several! Deteriorating organ function 2001 Nov ; 15 ( 6 ):601-7. doi: 10.1007/s100160010115 average patients... Were considerably more frequent in MfS patients ( 33.3 % ) underwent than.