Analysis of risk factors affecting mortality in proximal aortic surgery

Background: In this study, we aimed to investigate the incremental risk factors for mortality in patients undergoing proximal aortic surgery. Methods: Between January 2002 and June 2009, a total of 183 patients (116 males, 67 females, mean age: 59 14 years; range 23 to 82 years) were enrolled in this study. The preoperative risk factors were hypertension in 159 patients (86.8%), advanced age in 68 (37.1%), type 2 diabetes in 26 (14.2%), chronic obstructive pulmonary disease in 23 (%12.5), smoking in 106 (57.9%), nephropathy in 16 (8.7%), and cerebrovascular disease in 14 (7.6%). Except 79 patients with type A dissection who underwent surgery without coronary angiography, out of 104 patients with ascendant and arch aneurysm, 21 had coronary artery disease (20.1%). Seven patients (3.8%) previously underwent open heart surgery requiring sternotomy. The effects of the ascending aortic pathology, extent of the intervention to the pathological segment, cannulation techniques, methods of cerebral protection and the preoperative morbidity factors and the operative variables on the mortality and morbidity were assessed. Results: The in-hospital mortality rate was 15.3% in the overall group (20.2% in dissected patients and 11.5% in patients with an aneurysm). Multivariate regression analysis revealed that advanced age (4.31 times), chronic obstructive pulmonary disease (2 times), replacement extending to the arch (5.3 times), prolonged duration of cardiopulmonary bypass (4 times), preoperative hemodynamic instability (5.7 times), preoperative and postoperative nephropathy (1.6 and 2.4 times), central neuropathy (3.7 times), postoperative permanent neurological deficit (7.14 times), and vital organ malperfusion (12.5 times) increased the mortality. Conclusion: Proximal aortic surgery can be performed with acceptable mortality and morbidity rates. However, in this present study, we observed that preoperative or perioperative organ malperfusions significantly decreased the success of surgery in patients with type A aortic dissection requiring urgent surgery, in particular.