A rupture in the abdominal aorta results in … The causes of late death are shown in Table 4 . J Vasc Surg. Oxford University Press is a department of the University of Oxford. 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. Objective: Aortic aneurysms and dissections are the leading causes of premature death in Marfan syndrome (MfS). One of the patients received replacement of the entire aorta during several operations. A false aneurysm (pseudoaneurysm) is caused by blood leaking through the arterial wall but contained by the adventitia o… Risk factors were evaluated for early and late mortality, as well as for overall survival by univariate and multivariate analysis. Various operative techniques were used between 1975 and 1994. Despite the higher incidence of aortic dissection and limited preoperative functional status (NYHA class) in Marfan patients, the early mortality of these patients was similar to that in patients without MfS [18],[37]. There was no difference in gender distribution between MfS patients and not MfS related patients (220 male and 78 female). Find out the survival rate comparison between endovascular repair of abdominal aortic aneurysms and open surgery. Two MfS patients died in the operation room of uncontrollable bleeding due to the fragile aortic tissue. A history of loss of consciousness was also statistically significant. Epub 2013 Oct 20. The intraoperative mortality rate was 23%. Subjects: All patients who had had surgery for abdominal aortic aneurysm in Western Australia during 1985-94. 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. If the diameter has reached or exceeded 4 cm, we perform follow-up examination every 3 months. 2018 Mar;70(1):129-136. doi: 10.1007/s13304-017-0488-y. In order to improve the prognosis in these patients, the incidence of acute aortic dissection and redissection must be substantially reduced. All patients with acute dissections were classified as NYHA III or IV. Growth rate of >0.5 cm/y when the ascending aorta is <5.0 cm in diameter. Various causes of death were observed in group B, most of the patients suffered from deteriorating organ function. When there is no treatment for patients who are suffering from an aneurysm that is 5 centimeters above, the survival rate is only 20%. In order to reduce the high reoperation rate in MfS patients, frequent clinical follow-up may contribute to improve life expectancy in MfS patients. All living Marfan patients were seen at least annually between 1994 and 1997 in order to review their current status. [2]Women are much less frequently affected. Information concerning aortic dissection or dilatation was obtained from preoperative and postoperative aortic imaging studies. Harris DG, Garrido D, Oates CP, Kalsi R, Huffner ME, Toursavadkohi S, Darling RC 3rd, Crawford RS. Clipboard, Search History, and several other advanced features are temporarily unavailable. 2016 May 13;(5):CD011664. A number of surgical techniques for treatment of aortic aneurysms and dissections in MfS patients have been applied, resulting in a considerable variation of long-term results. Overall 5-year survival improved to 56% (95% CI, 48%-66%) between 1980 and 1994 compared with only 19% between 1951 and 1980 (P <.01). Without surgical repair, the annual survival rate is only about 20%. 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. An abdominal aortic aneurysm is an aneurysm (blood vessel rupture) in the part of the aorta that passes through the belly (abdomen). In another patient, the aortic valve showed no evidence of regurgitation and an isolated graft replacement was sufficient for treatment. Multiple aortic operations at different sections of the aorta are characteristic in MfS patients, an observation which has been described earlier [34],[35]. Epub 2019 Mar 21. Late survival after abdominal aortic aneurysm repair: influence of coronary artery disease. In order to increase the tensile strength and to obliterate the false lumen in the dissecting aorta, we used various adhesives: Fibrin glue, which was firstly applied in 1982, was replaced by resorcin-chinin glue in 1993. 2014 Jan;18(1):143-4. doi: 10.1093/icvts/ivt455. We recorded no statistically significant difference between the early mortality in the MfS group and group B. Factors influencing survival in 717 patients, Surgery extended into the aortic arch in acute type A aortic dissection: indications, techniques, results, Marfan Syndrome. To identify the factors affecting the high mortality rates associated with ruptured abdominal aortic aneurysm (AAA), a review was made of the records of 81 patients treated surgically between 1972 and 1983. These findings suggest that the factors (loss of consciousness, creatinine level, hemoglobin level) that are predictive of death may be a reflection of shock in this patient population. Five MfS patients (15.2%) and 50 patients (16.8%) of group B presented with aortic arch involvement. Ascending aortic aneurysm >4.5 cm in patients undergoing aortic valve surgery. The risk of rupture of the abdominal aortic aneurysm increases with size, wherein aneurysms larger than … Crawford recommended surgical treatment, if the external diameter exceeded 5 cm [22]. Long-term survival (Kaplan–Meier) in relation to the surgical technique used: composite graft (crosses) versus other procedures (squares). 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. Data other than Kaplan–Meier curves were expressed as the mean±S.D. Additionally, the absence of the treatment leads to 3%/h mortality rate within the first 24 hours. Please enable it to take advantage of the complete set of features! Further cardiac reinterventions are listed in Table 5. The causes of early death, as shown in Table 3 , were not different in both groups. Garland BT, Danaher PJ, Desikan S, Tran NT, Quiroga E, Singh N, Starnes BW. 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. aortic sizes greater than 4 cm, 5 cm, or 6 cm, is 5.3%, 6.5%, and 14.1%, respectively [2]. 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. 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. Three of 8 patients who underwent a Wheat procedure required reoperation because of a sinus valsalva aneurysm. Of MfS patients, 33.3% were classified as DeBakey type I, 24.2% as type II and 9.1% as type III. Davies R. R., Goldstein L. J., Coady M. A. et al. Kouchoukos reported good results in 127 patients who had composite graft insertion. No preoperative comorbid medical conditions were significant, nor was age. Univariate analysis of the relation between late mortality as well as overall survival and several predictive variables was carried out by means of log-rank statistic, followed by a multivariate analysis using the Cox regression model. Five Marfan patients (15.2%) and 51 patients of group B (17.1%) died within the first 30 days after operation of the thoracic aorta. Controlled hypotension versus normotensive resuscitation strategy for people with ruptured abdominal aortic aneurysm. Factors increasing the mortality rate for patients with ruptured abdominal aortic aneurysms. Also an emergency operation was a significant predictor for overall survival in the multivariate analysis. Yet, the major problem remains the rapid development and progression of aneurysmal dilatation. 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 Researchers found no significant differences in … A retrospective chart review of all patients who underwent repair of a ruptured abdominal aortic aneurysm was performed over a study period of 20 years.  |  COVID-19 is an emerging, rapidly evolving situation. 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.  |  This study aims to compare long-term results of surgically treated aortic aneurysms and dissections in patients with and without MfS in respect to early and late prognosis. In contrast, Pyeritz demonstrated that even in aortas with a diameter of less than 5 cm, dissections may occur [25]. The enlargement usually affects only a small part of the vessel, so bulge is a more accurate description. Acute Med Surg. 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. In addition, patients with acute dissection showed a significantly lower overall survival as well as a higher early mortality rate. Oyenuga AO, Folsom AR, Lutsey PL, Tang W. Vasc Med. 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. An aneurysm is caused by degradation of the elastic lamellae, a leukocytic infiltrate, enhanced proteolysis and smooth muscle cell loss. How is surgery for a thoracic aortic aneurysm completed? Acute dissections occurred in 57.6 (A) versus 37.9% (B). Would you like email updates of new search results? According to statistics, at least 20% of the patients die before they reach the hospital. A total of 29 patients in group B and 3 patients in the MfS group underwent concomitant operative procedures. 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. Without surgery, the annual survival rate is a mere 20%. What’s the best option for you? Statistical analysis was performed by SPSS statistical software for Windows 95 (Version 7.0, 1996). 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. Cancer and cardiac failure were the main causes of … The 10-year survival rate after the repair of an aortic aneurysm is 59 percent, as the National Center for Biotechnology Information reports. Epub 2018 May 9. Results: Up to now, more than 70 mutations in the FBN 1 gene have been described in association with MfS. MfS patients suffering from acute aortic dissection more likely required reoperation compared to patients with aortic aneurysm. In MfS patients, we did not use any repair because of the fragile aortic tissue. A total of 22 reoperations were performed in 11 MfS patients, 17 reoperations were due to recurrent aortic diseases. In group B, only 8 patients (3.2%) died, due to recurrent aortic disease (P≪0.001). Data was analyzed by both univariate and multivariate analysis. 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]. Surgery for acute dissection of ascending aorta: should the arch be included? In group B 26.5% were categorized as type I, 21.5% as type II and 2.7% as type III dissections. [Survival rate of patients with ascending aorta aneurysm and aortic valve regurgitation in the late postoperative period]. Design: Population based study. Two MfS patients (6.1%) and 17 patients (5.7%) of group B presented with aortic rupture. Aortic Surgery The Aorta Center in Cleveland Clinic’s Heart & Vascular Institute is organized to optimize the care of patients and to facilitate collaboration across disciplines with a focus on conditions that affect all segments of the aorta. Continuous data were analysed using the Mann–Whitney U-test, categorial data using χ2-test. Severe mitral valve insufficiency was present in 2 patients. These data were expressed as the mean±S.E. Long-term survival (Kaplan–Meier) of patients with Marfan syndrome (squares; group A) and patients with non-fibrillinopathic etiologies of aortic disease (crosses; group B). 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]. 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. 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. None of the patients with composite graft replacement needed reoperation in this segment, but 3 patients suffered from redissection at the proximal aortic arch. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. 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. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. In group B, the most common concomitant procedure was a coronary artery bypass graft in 27 patients (9.1%), 2 patients had mitral valve replacement. were able to demonstrate improved survival in patients, who received more extensive surgery at an earlier point of time, using composite graft replacement of the ascending aorta [29]. Topical application of cold saline solution (4°C) was used for myocardial protection. A total of 22 reoperations was performed in 11 MfS patients because of complications related to the primary operation, redissection, new aneurysm formation or other reasons as shown in Table 5 . J Vasc Surg . The present study demonstrates that reoperation and recidives were considerably more frequent in MfS compared to patients with non-fibrillinopathic etiologies of aortic disease. The causes of reoperation are shown in Table 5. Reoperations (P≪0.001) and recidives (P≪0.001) were significant risk factors for late death. Using this technique, the incidence of early and late pseudoaneurysms was markedly reduced [30]. We recorded 7 (25%, group A) versus 35 (14.2%, group B) late deaths among the 28 versus 247 early survivors. The surgical records were retrospectively reviewed.  |  All patients, who received aortic valve replacement or a composite aortic graft with mechanical prostheses were continued on anticoagulation with phenprocoumon (Marcumar®). Methods: Abdominal Aortic Aneurysm (Symptoms, Repair, Surgery, Survival Rate) See a detailed medical illustration of the heart plus our entire medical gallery of human anatomy and physiology See Images From Healthy Heart Resources Unfortunately, both methods present a risk of developing spinal cord injury and paralysis. 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. A total of 54.6% of patients in group A were treated with a composite graft versus 16.4% in B. Pharmaceuticals (Basel). Marsele et al. In the 1970s, aortic repair with resection of the aneurysmatic aortic segment and reconstruction by direct suture or patch interposition was preferentially used. 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. USA.gov. In 5 MfS patients (17.9%), late death was caused by redissection or rupture of an aneurysm between 17 to 98 months after first operation. Probability values (P) of less than 0.05 were considered significant. Another late death resulted from cerebral hemorrhage 14 years after aortic surgery. In group B, reoperations were significantly less frequent (10.7%) compared to MfS patients (66.7%; P≪0.001). Median survival of all patients was 13.1 years in group A and 20.1 years in group B. In group B, the majority of patients underwent Wheat’s operation (Table 2 ). 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. Moreno DH, Cacione DG, Baptista-Silva JC. HHS Nine MfS patients (27.3%) underwent more than one reoperation. Mortality rates and risk factors for emergent open repair of abdominal aortic aneurysms in the endovascular era. To assess the effects of laparoscopic surgery for elective abdominal aortic aneurysm repair. The effects of the hemoglobin level, creatinine level, and loss of consciousness on the mortality rate were strongest in patients who had a lowest preoperative systolic blood pressure greater than 90 mm Hg. In 1975, one patient was treated with the wrapping technique. Complications such as renal failure, infection, and stroke were also far below the 4 ). 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 … Operative therapy of thoracic aortic aneurysms and dissections are still representing a major surgical challenge associated with a high perioperative mortality. Abnormal enlargement or bulging of the aorta, the largest blood vessel of the body, is not an unusual condition. This test is most commonly used to diagnose abdominal aortic aneurysms. 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]. Since aortic dilatation frequently leads to dissection, early diagnosis and preventive surgical treatment must be a major goal in MfS patients. Using Bentall’s procedure, Gott et al. 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. 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. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. Search for other works by this author on: The Marfan syndrome: diagnosis and management, Fibrillin: a new 350-kD glycoprotein, is a component of extracellular microfibrils, Location on chromosome 15 of the gene defect causing Marfan Syndrome, Genetic linkage of Marfan syndrome, ectopia lentis, and congenital contractural arachnodactyly to the fibrillin genes on chromosomes 15 and 5, Defects in the fibrillin gene cause the Marfan syndrome: linkage evidence and identification of a missense mutation, Linkage of Marfan Syndrome and a phenotypically related disorder to two different fibrillin genes, Localization of the fibrillin (FBN) gene to chromosome 15, band q21.1, The Marfan syndrome locus: confirmation of assignment to chromosome 15 and identification of tightly linked markers at 15q15-q21.3, Cardiovascular manifestations of Marfan’s syndrome in the young, A prospectus on the prevention of aortic rupture in the Marfan Syndrome with data on survivorship without treatment, Life expectancy and causes of death in the Marfan Syndrome, Dissection and dissecting aneurysms of the aorta: twenty-years follow-up of five hundred twenty-seven patients treated surgically, International nosology of heritable disorders of connective tissue, Berlin, 1986, Progression of aortic dilatation and the benefit of long-term ß-adrenergic blockage in Marfan’s syndrome, A technique for complete replacement of the ascending aorta, Successful replacement of the entire ascending aorta and aortic valve, Non parametric estimation from incomplete observations, Surgical management of aortic dissection in patients with the Marfan Syndrome, Surgical treatment of aneurysms of the ascending aorta in the Marfan Syndrome, Composite graft repair of Marfan aneurysm of the ascending aorta: results in 100 patients, Marfan’s syndrome: broad spectral surgical treatment cardiovascular manifestations, Diffuse aneurysmal disease (chronic aortic dissection, Marfan, and mega aorta syndromes) and multiple aneurysm, Surgical treatment of cardiovascular complications in Marfan syndrome: a 27-year experience, Impact of cardiovascular operation on survival in the Marfan patient, Marfan Syndrome: current and future clinical and genetic management of cardiovascular manifestations, Acute and chronic aortic dissections: determinants of long-term outcome for operative survivors. A total of 22 MfS patients had to undergo surgery due to acute (57.6%) or chronic (9.1%) aortic dissections. By univariate analysis of various factors associated with the mortality rate, hemoglobin level, creatinine level, lowest preoperative and average intraoperative systolic blood pressure, packed red blood cells transfused, estimated blood loss, intraoperative urine output, and temperature were statistically significant. The dilatation affects all three layers of the arterial wall. Use of the Hardman index in predicting mortality in endovascular repair of ruptured abdominal aortic aneurysms. Results: We observed 7 (25.0%, A) versus 35 (14.2%, B) late deaths among the 28 (A) versus 247 (B) early survivors. 10.9 % mortality rate compared to 10.9 % mortality across the country not be denied therapy on basis... Crawford RS recent risk factors for late mortality, as shown in Table 5 18 ( 1.... 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