Elsevier

The Annals of Thoracic Surgery

Volume 90, Issue 5, November 2010, Pages 1437-1443
The Annals of Thoracic Surgery

Original article
Adult cardiac
Reoperations for Aortic False Aneurysms After Cardiac Surgery

https://doi.org/10.1016/j.athoracsur.2010.06.103Get rights and content

Background

Aortic false aneurysm is a rare complication after cardiac surgery. Aortic dissection, infection, arterial wall degeneration, and poor surgical technique are recognized as risk factors for the occurrence of postsurgical false aneurysm. Despite some recent reports about percutaneous false aneurysm exclusion, a complex surgical reoperation is needed in most of the cases.

Methods

We retrospectively reviewed our experience in 43 patients who received a reoperation for postsurgical aortic false aneurysm in the last 14 years. Thirty-three patients were male. The mean age was 60 ± 12 years. Most of the patients received prior aortic surgery on the aortic root, the ascending aorta, the aortic arch, and the descending thoracic aorta (38 patients). False aneurysm was diagnosed during follow-up evaluation in the absence of any symptoms in 23 cases. Univariate and multivariate analyses on 18 perioperative variables were performed.

Results

In-hospital mortality was 6.9% (3 patients). The postoperative course was complicated in 17 cases (39%). At multivariate analysis, a preoperative history of coronary artery disease and postoperative sepsis were independent risk factors for hospital mortality. Survival rates at 1, 5, and 10 years were 94%, 79%, and 68%, respectively. Freedom from reoperation was 86% at 1 year and 72% at 5 and 10 years.

Conclusions

Despite a high postoperative complication rate, a reoperation for postsurgical aortic false aneurysm can be performed with acceptable mortality and good mid-term and long-term outcomes.

Section snippets

Patient Population

Between January 1995 and October 2009, 43 consecutive patients underwent a reoperation for false aneurysm involving the thoracic aorta from the aortic root to the distal arch. The ethics committee of the St. Antonius Hospital, Nieuwegein, the Netherlands, approved the study and waived the need for patient consent. The mean age of the patients at the time of reoperation was 60 ± 12 years (range, 31 to 80 years), and 33 (77%) were male. The mean interval between the previous procedure and the

Clinical Presentation

The false aneurysm was diagnosed during routine follow-up examination in 23 asymptomatic patients. Symptoms varied according to the location and the size of the false aneurysm (Table 4).

False Aneurysm Site and Cause

Details of the false aneurysm site are reported in Table 5. The cause was unknown in 15 patients. The interval between the prior and the actual operation in this cohort of patients was 12.2 ± 11.1 years. Disease of the aortic wall was present in 26 patients; 7 of them were Marfan, and 17 had previous aortic

Comment

This study was undertaken to evaluate the outcome in a cohort of 43 patients undergoing reoperation for false aortic aneurysm after cardiovascular surgery during a period of 14 years. Hospital mortality was 6.9%, which is relatively low compared with previous reports that showed a mortality rate up to 18% [1, 4, 7, 8, 12]. Most of the literature available contains isolated case reports and small cohorts of patients [13, 14, 15]; more important experiences reported a mortality of 14% ± 7% [1, 4,

References (28)

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