Influence of aortitis on late outcomes after repair of ascending aortic aneurysms.

Abstract

To determine outcomes of repair of ascending aortic aneurysms in patients with histopathologic diagnoses of aortitis. We reviewed histopathologic findings and outcomes of elective repair of ascending aortic aneurysms between January 1, 1955, and December 31, 2012. Noninfectious aortitis was identified in 186 patients, and we compared outcomes for these patients with outcomes for others operated on at the same time with diagnoses of medial degeneration (n = 317) or atherosclerosis (n = 232). Early mortality (<30 days postoperatively) for patients with aortitis was 2%, and overall 10-year survival was 45%, compared with 66% for patients with medial degeneration, and 45% for patients with atherosclerosis (P < .001 vs medial degeneration). In addition to histopathologic diagnosis, overall mortality was influenced by older age at operation (hazard ratio [HR]: 1.060; 95% confidence interval [CI], 1.046-1.077; P < .001), chronic obstructive pulmonary disease (HR: 1.560; 95% CI: 1.136-2.136; P = .006); concomitant coronary artery bypass grafting (HR: 1.980; 95% CI: 1.520-2.600; P < .001); and use of circulatory arrest (HR: 1.500; 95% CI: 1.148-1.960; P = .003). Risk of aortic reoperation at 10 years was 21% for aortitis patients, compared with 11% for those with medial degeneration, and 19% for patients with atherosclerosis (P = .028). Patients with repaired ascending aneurysms secondary to noninfectious aortitis have low early mortality, but late risks of death and aortic reoperation are increased, compared with these outcomes for patients with aneurysms that result from medial degeneration.