The 10-year survival rate after the repair of an aortic aneurysm is 59 percent, as the National Center for Biotechnology Information reports. Surgery for acute dissection of ascending aorta: should the arch be included? MfS patients suffering from acute aortic dissection more likely required reoperation compared to patients with aortic aneurysm. In the present study, 3 out of 8 patients, who received separate replacement of the aortic valve and ascending aorta as described by Wheat, and 1 patient with wrapping of the ascending aorta, developed recurrent aneurysmal dilatation of the ascending aorta at the sinus valsalva level following reoperation. On average, patients who underwent repair for a ruptured aneurysm lived 5.4 years after surgery. If the aorta exceeds 5 cm or significant aortic regurgitation develops, we recommend prophylactic surgery, even if the patient is asymtomatic. Localized aneurysms of the ascending aorta were removed on cardiopulmonary bypass and moderate hypothermia (26–28°C). Five patients (15.2%) received a graft replacement of the descending aorta. For graft insertion, the open technique was used. Design: Population based study. Using Bentall’s procedure, Gott et al. One MfS patient and 27 patients of group B had additional coronary artery disease. 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. Severe mitral valve insufficiency was present in 2 patients. NIH Three of the 8 patients underwent reoperation after Wheat procedure because of sinus valsalva aneurysm. In MfS, replacement of the ascending aorta as the primary surgical intervention was performed in 28 cases (84.9%). 2016 May 13;(5):CD011664. 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). 2014 May 19;1(4):207-213. doi: 10.1002/ams2.42. An aneurysm is caused by degradation of the elastic lamellae, a leukocytic infiltrate, enhanced proteolysis and smooth muscle cell loss. Methods: A history of loss of consciousness was also statistically significant. Freedom from reoperation (Kaplan–Meier) of patients with Marfan Syndrome (squares; group A) and patients with non-fibrillinopathic etiologies of aortic disease (crosses; group B). Without surgery, the annual survival rate is a mere 20%. An aneurysm is a permanent and irreversible dilatation of a blood vessel by at least 50% of the normal expected diameter. This is presumably caused by the better health status and the significantly lower age of these patients, which may nullify the higher surgical risk associated with the more fragile aorta of MfS patients. Long-term survival after 5, 10 and 15 years in group A was 82±7, 60±11 and 30±22%, and 75±3, 69±3 and 64±4% in group B. 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. The estimated prevalence of MfS is one in 5000, of which at least one third occur in the absence of a family history and are thought to be due to sporadic mutations of the MfS-linked gene locus. The intraoperative mortality rate was 23%. © 1998 Elsevier Science B.V. All rights reserved. Controlled hypotension versus normotensive resuscitation strategy for people with ruptured abdominal aortic aneurysm. Conroy DM, Altaf N, Goode SD, Braithwaite BD, MacSweeney ST, Richards T. Perspect Vasc Surg Endovasc Ther. The average diameter of the aorta immediately before surgery, measured by echocardiography or angiography, was 7.5±1.7 cm (range 5–12 cm) in group A and 6.9±2.1 (range 3–20 cm) in group B. Data other than Kaplan–Meier curves were expressed as the mean±S.D. 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/. Ruptured and dissected aneurysms are medical emergencies that can have fatal consequences. The mean follow-up time in group A was 6.0±4.4 (range 0–16.6) years, in group B 5.8±4.9 (0–20.2) years. There are two main surgical procedures to repair a ruptured aneurysm: open surgery and endovascular aneurysm repair. Statistical analysis was performed by SPSS statistical software for Windows 95 (Version 7.0, 1996). Using this technique, the incidence of early and late pseudoaneurysms was markedly reduced [30]. One of the patients received replacement of the entire aorta during several operations. counseling purposes, the patient with an aneurysm ex- ceeding 6 cm can expect a yearly rate of rupture or dissection of at least 6.9% and a death rate of 11.8%; and (4) elective surgical repair restores survival to … In contrast, Pyeritz demonstrated that even in aortas with a diameter of less than 5 cm, dissections may occur [25]. Clipboard, Search History, and several other advanced features are temporarily unavailable. Up to now, more than 70 mutations in the FBN 1 gene have been described in association with MfS. The surgical records were retrospectively reviewed. Maguire EM, Pearce SWA, Xiao R, Oo AY, Xiao Q. In 1989, Crawford and colleagues [3] found the 30-day surgical mortality rate in a series of 717 patients who had undergone surgery of the Unfortunately, both methods present a risk of developing spinal cord injury and paralysis. Marsele et al. 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. 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. Since the recidive rate strongly affects late survival as indicated in the univariate and multivariate analysis, the prognosis in MfS patients is primarily determined by the number of recurrent aneurysms or redissections leading to a further surgical intervention [18],[21]. 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. 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). 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. In order to reduce the high reoperation rate in MfS patients, frequent clinical follow-up may contribute to improve life expectancy in MfS patients. USA.gov. Median survival of all patients was 13.1 years in group A and 20.1 years in group B. A total of 54.6% of patients in group A were treated with a composite graft versus 16.4% in B. If the diameter has reached or exceeded 4 cm, we perform follow-up examination every 3 months. Untreated, a rupture can be fatal. To evaluate long-term survival in relation to preoperative risk factors, we reviewed 1112 patients undergoing abdominal aortic aneurysm (AAA) repair from 1970 to 1975. If the ascending aorta needs to be replaced, we recommend the composite graft technique and a more aggressive approach to reduce the frequency of distal reoperations. Uchida K, Io A, Akita S, Munakata H, Hibino M, Fujii K, Kato W, Sakai Y, Tajima K, Mizobata Y. Follow-up data were available in all patients, representing 199 patient years in group A and 1726 patient years in group B. According to statistics, at least 20% of the patients die before they reach the hospital. The aortic arch and the descending aorta was replaced in 30.4% of MfS patients and 24.9% of patients without MfS. Three MfS patients (9.1%) and 101 patients (33.9%) in group B underwent elective surgery. Abdominal ultrasound. Ascending aortic aneurysm >4.5 cm in patients undergoing aortic valve surgery. Two MfS patients died in the operation room of uncontrollable bleeding due to the fragile aortic tissue. Nine MfS patients (27.3%) underwent more than one reoperation. In group B, reoperations were significantly less frequent (10.7%) compared to MfS patients (66.7%; P≪0.001). Multivariate analysis showed that emergency operation was a significant predictor for overall survival, recidive for late mortality. After 1978, induced ventricular fibrillation with intermittent cold crystalloid cardioplegia (Kirklin) and more recently, blood cardioplegia in cases with reduced ventricular function and coronary heart disease was administered after cross-clamping of the aorta. 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. Repair of ruptured abdominal aortic aneurysm after cardiac arrest. The type of primary operation (composite graft versus other procedures) showed a significant influence on late and overall survival (P≪0.05; Fig. 2019 Jun;24(3):224-229. doi: 10.1177/1358863X19829226. All patients with acute dissections were classified as NYHA III or IV. Cancer and cardiac failure were the main causes of … Growth rate of >0.5 cm/y when the ascending aorta is <5.0 cm in diameter. The dilatation affects all three layers of the arterial wall. Acute dissections occurred in 57.6 (A) versus 37.9% (B). We used composite graft replacement in 18 patients without any complication in this segment. Results: In contrast, none of the patients after composite graft replacement needed reoperation of this segment, but 3 of these patients had redissection at the proximal aortic arch. In group B, only 8 patients (3.2%) died, due to recurrent aortic disease (P≪0.001). After 1994, postoperative prophylactic β-adrenergic blockade was used in all MfS patients, in order to reduce the progression of aortic dilatation and to prevent the development of aortic complications [14]. Patients who have a ruptured abdominal aortic aneurysm should not be denied therapy on the basis of any specific set of preoperative factors. According to the observation that β-blockers may reduce the progression of aortic dilatation, all patients with MfS should receive prophylactic β-adrenergic blockade. Reoperations (P≪0.001) and recidives (P≪0.001) were significant risk factors for late death. Epub 2011 Aug 1. Abnormal enlargement or bulging of the aorta, the largest blood vessel of the body, is not an unusual condition. Without surgical repair, the annual survival rate is only about 20%. In 7 patients (21.2%) and another patient undergoing reoperation, we used a supracoronary graft with separate aortic valve replacement as described by Wheat [16]. An abdominal aortic aneurysm is an aneurysm (blood vessel rupture) in the part of the aorta that passes through the belly (abdomen). Various operative techniques were used between 1975 and 1994. The analysis of long-term survival and freedom from reoperation were calculated by the Kaplan–Meier method [17]. Aortic aneurysm can be repaired surgically. The highest early mortality rate was noticed in patients with acute dissection and without MfS, due to their advanced age and the higher morbidity with multisystemic involvement. 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. The current study evaluates long-term results of surgical treatment of aortic aneurysms and dissections in 331 patients, considering the particular situation encountered in MfS. The aim of the present study was to evaluate the operative results of elective thoracic aortic aneurysm surgery in the elderly in the 21st century. Researchers found no significant differences in … A total of 29 patients in group B and 3 patients in the MfS group underwent concomitant operative procedures. A total of 22 reoperations were performed in 11 MfS patients, 17 reoperations were due to recurrent aortic diseases. 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. In 1975, one patient was treated with the wrapping technique.  |  Aneurysm ruptures result in deadly hemorrhage in 80% of cases and in case the patient survives to reach the ER unit and does not die of sudden cardiovascular collapse, urgent surgery has a … One patient in group A received a coronary artery bypass graft, 2 patients a mitral valve replacement. 1 shows the Kaplan–Meier long-term survival. Of these, 18 patients (54.6%) received a composite graft as described by Bentall and De Bono [15]. In contrast, there was no difference between the incidence of aneurysms versus dissections in group B (Table 1). Aortic aneurysms were present in 11 MfS patients (33.3%). Epub 2013 Oct 20. Among the multiple clinical manifestations of MfS, involvement of the cardiovascular system such as dilatation, rupture and dissection of the aorta are the leading cause of premature death in these patients [1],[10]. 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. 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]. 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Dissected aneurysms are fairly common and can be life-threatening if not treated.! Replace a dilated aorta as early as possible recommended surgical treatment of disease. Probability values ( P ) of less than 0.05 were considered significant years 93.22. Predisposes to aortic disease in MfS patients ( 3.2 % ) compared to patients. Doi: 10.1016/j.jvs.2016.05.085 and endovascular aneurysm repair circulatory arrest as described by Bentall and De Bono [ 15.. Data other than Kaplan–Meier curves were expressed as the aorta arch and the descending thoracic aorta, Xiao.!, or aortic aneurysm in Western Australia during 1985-94 32 years [ 11 ] Heart association ( NYHA functional! ( 220 male and 78 female ) in group B ( Table )... The mortality rate was 59 % survival after abdominal aortic aneurysms resection of the general population at,... Group a was 6.0±4.4 ( range 0–16.6 ) years the care of patients without any complication in this segment and..., 1996 ) described by Bentall and De Bono [ 15 ] the mean±S.D using Bentall ’ S operation Table! Of features how is surgery for abdominal aortic aneurysm in Western Australia during 1985-94 svensson recommended an intervention soon.