The influence of comorbid pathology on postoperative complications and mortality after surgical correction of ascending aortic aneurisms and dissection

Authors: Gelashvili M.M., Mironenko V.A., Kuts E.V., Rychin S.V., Garmanov S.V., Kokoev M.B., Brovich K.N.

Company: Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russian Federation

UDC: 616.132.2-007-089.168.1-06
DOI: https://doi.org/10.24022/1810-0694-2021-22-5-554-561

Cite as: Gelashvili M.M., Mironenko V.A., Kuts E.V., Rychin S.V., Garmanov S.V., Kokoev M.B., Brovich K.N. The influence of comorbid pathology on postoperative complications and mortality after surgical correction of ascending aortic aneurisms and dissection. The Bulletin of Bakoulev Center. Cardiovascular Diseases. 2021; 22 (5): 554–61 (in Russ.). DOI: 10.24022/1810-0694-2021-22-5-554-561

Received / Accepted: 28.06.2021 / 24.08.2021

Keywords: aortic aneurysm aortic dissection comorbidity obesity chronic obstructive pulmonary disease diabetes mellitus chronic kidney disease genetic pathology central nervous system damage thyroid damage chronic pancreatitis chronic cholecystitis comprehensive assessment of weakness postoperative mortality complications

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Abstract

Aortic aneurysms treatment dissections remains one of the most challenging issues in cardiovascular surgery today. Сomorbidities in this cohort of patients could have a significant impact on the surgical treatment results. Сomorbidities could lead to a post-operative complications, increased post-operative intensive care unit and hospital stay and increased in mortality even in absence of procedure-related surgical complications.

Purpose: to conduct a retrospective analysis of comorbidities in patients with aneurysm and dissection of the ascending aorta and to identify risk factors of post-operative complications.

Material and methods. The retrospective study included 288 patients aged 13 to 81 years who underwent surgical treatment on the ascending aorta under the artificial circulation during the period from 2016 to 2020. Ascending aortic aneurysm was diagnosed in 77.4% of cases, chronic aortic dissecting aneurysm in 22.6% of cases. The majority of patients had one or more comorbidities.

Results. The comorbidities in patients with aneurysm of the ascending aorta or its dissection had a direct impact on postoperative complications rate and the surgical treatment result. The analysis showed statistical significance of chronic obstructive pulmonary disease (n = 64) for the development of postoperative respiratory failure (p = 0.025) and for mortality (p = 0.04). The chronic renal failure (n = 33) is also statistically significant and contributes to the development of acute renal failure (p = 0.007) and an unfavorable outcome (p = 0.06). The Marfan's syndrome (n = 15) significantly affects the respiratory function and increases the artificial lung ventilation (p = 0.009).

Conclusion. Сhronic obstructive pulmonary disease and chronic kidney disease can influence postoperative mortality. Also the connective tissue dysplasia is also predictors of a complicated postoperative period in patients with aneurysm and dissection of the ascending aorta.

References

Tchana-Sato V., Sakalihasan N., Defraigne J.O. Aortic dissection. Rev. Med. Liege. 2018; 73 (5–6): 290–5.
Silaschi M., Byrne J., Wendler O. Aortic dissection: medical, interventional and surgical management. Heart. 2017; 103 (1): 78–87. DOI: 10.1136/heartjnl-2015-308284
Fattori R., Cao P., De Rango P., Czerny M., Evangelista A., Nienaber C. et al. Interdisciplinary expert consensus document on management of type B aortic dissection. J. Am. Coll. Cardiol. 2013; 61: 1661–78. DOI: 10.1016/j.jacc.2012.11.072
Scandroglio A.M., Finco G.P., Pieri M., Ascazi R., Calabro M.G., Taddeo D. et al. Cardiac surgery in 260 octogenarians: a case. BMC Anesthesiol. 2015; 15 (15). DOI: 10.1186/1471-2253-15-15
Chiu P., Miller D.C. Evolution of surgical therapy for Stanford acute type A aortic dissection. Ann. Cardiothorac. Surg. 2016; 5 (4): 275–95. DOI: 10.21037/acs.2016.05.05
Belov Yu.V., Komarov R.N., Katkov A.I., Vinokurov I.A., Stonogin A.V., Lednev P.V. Aortic root exoprosthetics as a variant of aortic regurgitation management. Cardiology and Cardiovascular Surgery. 2016; 9 (3): 94–6 (in Russ.). DOI:10.17116/kardio20169394-96
Buddeke J., Bots M.L., van Dis I., Visseren F.LJ., Hollander M., Schelevis F.G. Comorbidity in patients with cardiovascular disease in primary care: a cohort study with routine healthcare data. Br. J. Gen. Pract. 2019; 69 (683): e398–e406. DOI: 10.3399/bjgp19X702725
Kondoh H., Satoh H., Daimon T., Tauchi Y., Yamamoto J., Abe K. et al. Outcomes of limited proximal aortic replacement for type A aortic dissection in octogenarians. J. Thorac. Cardiovasc. Surg. 2016; 152 (2): 439–46. DOI: 10.1016/j.jtcvs.2016.03.093
Di Eusanio M., Trimarchi S., Patel H.J., Hutchison S., Suzuki T., Peterson M.D. et al. Clinical presentation, management, and short-term outcome of patients with type A acute dissection complicated by mesenteric malperfusion: observations from the International Registry of Acute Aortic Dissection. J. Thorac. Cardiovasc. Surg. 2013; 145: 385–390 e1. DOI: 10.1016/j.jtcvs.2012.01.042
Bockeria L.A., Garmanov S.V. Surgical treatment of aneurysms of the ascending aorta and aortic arch with the use of selective antegrade cerebral perfusion. Annals of Surgery. 2013; 3: 23–30 (in Russ.).
Mironenko V.A., Darvish N.A., Garmanov S.V., Gordeychuk N.V. Prosthesis of the ascending aorta, arch and brachiocephalic arteries using adaptive perfusion in a patient with brain malperfusion. Russian Journal of Thoracic and Cardiovascular Surgery. 2019; 61 (6): 532–7 (in Russ.). DOI: 10.24022/0236-2791-2019-61-6-532-537
Liao K.M., Chen Ch.Y. Impact of chronic obstructive pulmonary disease on patients with aortic aneurysms: a Nationwide Retrospective Cohort Study in Taiwan. BMJ Open. 2017; 7: e015806. DOI: 10.1136/bmjopen-2016-015806
Pyeritz R.E. Marfan syndrome: improved clinical history results in expanded natural history. Genet. MED. 2019; 21 (8): 1683–90. DOI: 10.1038/s41436-018-0399-4
Zhou T., Li J., Sun Y., Gu J., Zhu K., Wang Y. et al. Surgical and early outcomes for type A aortic dissection with preoperative renal dysfunction stratified by estimated glomerular filtration rate. Eur. J. Cardiothorac. Surg. 2018; 54 (5): 940–5. DOI: 10.1093/ejcts/ezy157
Avdic T., Franzen S., Zarrouk M., Acosta S., Nilsson P., Gottsäter A. et al. Reduced long-term risk of aortic aneurysm and aortic dissection among individuals with type 2 diabetes mellitus: A Nationwide Observational Study. J. Am. Heart Assoc. 2018: 24; 7 (3): e007618. DOI: 10.1161/JAHA.117.007618
Khugaeva A.A., Nikitina T.G. Immediate results of surgical treatment of valvular heart disease in patients 75 years of age and older. Risk factors and predictors of hospital mortality. Russian Journal of Thoracic and Cardiovascular Surgery. 2017; 59 (4): 259–65 (in Russ.). DOI: 10.24022/ 0236-2791-2017-59-4-259-265
Patrat-Delon S., Rouxel A., Gacouin A., Revest M., Flecher E., Fouquet O. et al. EuroSCORE II underestimates mortality after cardiac surgery for infective endocarditis. Eur. J. Cardiothorac. Surg. 2016; 49: 944e51. DOI: 10.1093/ejcts/ezv223

About the authors

Melano M. Gelashvili, Cardiologist; ORCID
Vladimir A. Mironenko, Dr. Med. Sci., Cardiovascular Surgeon; ORCID
Eleonora V. Kuts, Dr. Med. Sci., Cardiologist; ORCID
Sergey V. Rychin, Dr. Med. Sci., Cardiovascular Surgeon; ORCID
Sergey V. Garmanov, Cand. Med. Sci., Cardiovascular Surgeon; ORCID
Murat B. Kokoev, Cand. Med. Sci., Cardiovascular Surgeon; ORCID
Kseniya N. Brovich, Cardiologist

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Chief Editor

Elena Z. Golukhova, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, Director of Bakoulev National Medical Research Center for Cardiovascular Surgery

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