Operative Mortality & Morbidity

"Elective" vs. "Emergency" Aortic Surgery

Operations on the aorta may be performed electively or as emergency surgery. Of those done electively, surgery may be performed 1) to prevent a problem from occurring, or 2) to improve symptoms.

Elective Surgery

Patients who undergo elective aortic surgery at the Aortic Surgery Program can expect excellent outcomes immediately after surgery and in the long term. At this center, the risk of death or complications is exceptionally low. Operative outcomes at this center include the following.

All Aortic root replacement (emergency+elective) 1

Mortality: 3.7%
All complications: 12%
(including respiratory failure, wound infection, pericardial effusion (fluid around the heart), stroke, or need for pacemaker)

In patients of all ages, outcomes for aortic root surgery using axillary cannulation are excellent.

Aortic root and valve replacement using First Generation Columbia Bioroot 2

Operative mortality: 2.9%

Aortic root and valve replacement using Second Generation Columbia Bioroot 3

Operative mortality: 2.0%
Stroke: 0

Valve-sparing aortic root replacement 4

Operative mortality in all patients: 0
1-year mortality in patients under age 70: 0
1-year mortality in patients aged 70-80: 6.7%
1-year mortality in patients over age 80: 15.8%

Total aortic arch reconstruction using hybrid endovascular approach, without hypothermic circulatory arrest 5

mortality: 11%
Total aortic arch reconstruction using hybrid endovascular approach, with hypothermic circulatory arrest:
mortality: 18%

Emergency Surgery

Acute Type A Dissection

Traditionally, emergency surgery in patients with acute Type A aortic dissection has been associated with significant risk. At this center, we previously repaired Type A dissections using traditional surgical methods, which included profound hypothermic circulatory arrest. Beginning in 2008, we altered our strategy to use antegrade cerebral perfusion, mild hypothermia, and full aortic root replacement. This change has significantly improved surgical outcomes.

Acute aortic dissection with repair using Generation I Columbia Bioroot 6

Operative mortality: 2.9% (patients with acute aortic dissection)

References

  1. Open distal anastomosis in aortic root replacement using axillary cannulation and moderate hypothermia. - Takayama H; Smith CR; Bowdish ME; Stewart AS - J Thorac Cardiovasc Surg - 01-JUN-2009; 137(6): 1450-3.
  2. Modified Bentall operation with bioprosthetic valved conduit: Columbia University experience. Tabata M; Takayama H; Bowdish ME; Smith CR; Stewart AS - Ann Thorac Surg - 01-JUN-2009; 87(6): 1969-70.
  3. Modified Bentall operation with a novel biologic valved conduit. Stewart AS; Takayama H; Smith CR - Ann Thorac Surg - 01-MAR-2010; 89(3): 938-41.
  4. Safety of Valve-sparing Aortic Root Surgery in Septuagenarians and Octogenarians. Iribarne, A. Presented at the AATS Aortic Symposium in April 2010; currently in press.
  5. Use of carotid-subclavian arterial bypass and thoracic endovascular aortic repair to minimize cerebral ischemia in total aortic arch reconstruction. - Xydas S, Wei B, Takayama H, Russo M, Bacchetta, Smith CR, Stewart AS. - J Thorac Cardiovasc Surg - 01-MAR-2010; 139(3): 717-22; discussion 722.
  6. Modified Bentall operation with bioprosthetic valved conduit: Columbia University experience. Tabata M; Takayama H; Bowdish ME; Smith CR; Stewart AS - Ann Thorac Surg - 01-JUN-2009; 87(6): 1969-70.