Ascending Aortic Surgery for Small Aneurysms in Men and Women

Panfilov, Dmitri; Saushkin, Victor; Sazonova, Svetlana; Kozlov, Boris

doi:10.21470/1678-9741-2022-0179

Acessibilidade / Reportar erro

Brasil

Brazilian Journal of Cardiovascular Surgery

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

ORIGINAL ARTICLE • Braz. J. Cardiovasc. Surg. 39 (1) • 2024 • https://doi.org/10.21470/1678-9741-2022-0179 copy

Ascending Aortic Surgery for Small Aneurysms in Men and Women

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Introduction:

According to recent data, thoracic aortic surgery has reduced morbidity and mortality including ascending aortic aneurysm treatment; however, women are at increased postoperative risk of adverse outcomes.

Objective:

Our aim was to evaluate early and late outcomes in male and female patients who underwent pre-emptive ascending aortic replacement (AAR).

Methods:

From January 2013 to September 2021, 91 patients (56 [61.5%] men and 35 [38.5%] women) underwent AAR for small (ranged from 5.0 to 5.5 cm) non-syndromic aneurysms. A propensity score-based adjustment of the groups was performed. We compared clinical outcomes between males and females.

Results:

Preoperative normalized aortic diameters were significantly larger in females (2.9 [2.7; 3.2] cm/m²) than in males (2.5 [2.3; 2.6] cm/m², P<0.001), without differences in absolute values (51 [49; 53] mm vs. 52 [50; 53] mm, P=0.356). There were no significant differences in neurological, cardiac, pulmonary, and renal complications in both groups before and after matching. In-hospital mortality was 1 (1.8%) and 2 (5.7%) (P=0.307) in male and female patients in unmatched groups and 1 (2.9%) and 2 (5.7%) (P=0.553) in matched groups, respectively. Univariate logistic regression analysis revealed that the only risk factor for in-hospital mortality was age (odds ratio 1.117, 95% confidence interval 1.003-1.244; P=0.04). The overall survival rate was 83.5±0.06% in men and 94.3±0.04% in women at 36 months (P=0.404).

Conclusion:

Ascending aortic surgery for aneurysms ranged from 5.0 to 5.5 cm seems to have tolerable early and late outcomes in men and women.

Keywords:
Aortic Aneurysm; Aortic Replacement; Sex Characteristics; Survival Analysis; Morbidity

Abbreviations, Acronyms & Symbols
AAR	= Ascending aortic replacement
AVR	= Aortic valve replacement
BMI	= Body mass index
BSA	= Body surface area
CABG	= Coronary artery bypass grafting
CI	= Confidence interval
CKD-EPI	= Chronic Kidney Disease Epidemiology Collaboration
ICU	= Intensive care unit
OR	= Odds ratio
SMD	= Standardized mean difference
TND	= Temporary neurological deficit

Variable	Before matching				After matching
	Men (n=56)	Women (n=35)	P-value	SMD	Men (n=35)	Women (n=35)	P-value	SMD
Age, years	60.5 [53.5; 65]	61 [54; 67]	0.526	0.247	60 [54; 63]	61 [54; 67]	0.869	0.065
> 70 years old, n (%)	5 (8.9%)	4 (11.4%)	0.697	0.077	4 (11.4%)	4 (11.4%)	> 0.999	0.001
BMI, kg/m²	28.9 [26; 32]	27.2 [24.4; 32.7]	0.225	0.174	29.4 [28; 31.5]	27.2 [24.4;32.7]	0.628	0.116
BSA, m²	2 [1.9; 2.2]	1.8 [1.6; 1.9]	< 0.001	-1.577	1.8 [1.8; 2]	1.8 [1.6; 1.9]	< 0.001	-0.876
Ascending aortic diameter, mm	51 [49; 53]	52 [50; 53]	0.356	0.061	51 [50; 52]	52 [50; 53]	0.508	0.155
Normalized aortic diameter, cm/m²	2.5 [2.3; 2.6]	2.9 [2.7; 3.2]	< 0.001	1.188	2.7 [2.5; 2.8]	2.9 [2.7; 3.2]	0.001	0.724
Hypertension, n (%)	38 (67.9%)	21 (60%)	0.445	-0.158	21 (60%)	21 (60%)	> 0.999	0.001
Diabetes mellitus, n (%)	5 (8.9%)	2 (5.7%)	0.575	-0.136	1 (2.9%)	2 (5.7%)	0.553	0.001
Coronary artery disease, n (%)	19 (33.9%)	8 (22.9%)	0.260	-0.260	10 (28.6%)	8 (22.9%)	0.456	0.001
Chronic obstructive pulmonary disease, n (%)	6 (10.7%)	1 (2.9%)	0.171	-0.465	1 (2.9%)	1 (2.9%)	> 0.999	0.001
Atrial fibrillation, n (%)	11 (19.6%)	3 (8.6%)	0.154	-0.390	4 (11.4%)	3 (8.6%)	0.553	0.001
Left ventricular ejection fraction, %	62 [54.5; 64]	65.5 [63; 68]	< 0.001	1.139	62.8 [56; 64]	65.5 [63; 68]	0.179	0.308
Left ventricular ejection fraction (< 40%), n (%)	3 (5.4%)	1 (2.9%)	0.571	-0.148	1 (2.9%)	1 (2.9%)	> 0.999	0.001
Creatinine, mg/dl	94.7±14.7	75.6±12.1	< 0.001	-1.544	85.1±13.2	75.6±12.1	< 0.001	-0.781
Glomerular filtration rate, ml/min/1.73 m² (CKD-EPI formula)	79.2±2.6	77±3.1	0.627	-0.167	78.5±1.8	77±3.1	0.831	0.001
Previous cerebrovascular accident, n (%)	3 (5.4%)	5 (14.3%)	0.143	0.251	2 (5.4%)	5 (14.3%)	0.235	0.161
Previous cardiac surgery, n (%)	2 (3.6%)	1 (2.9%)	0.852	-0.042	1 (2.9%)	1 (2.9%)	> 0.999	0.001

Variable	Before matching				After matching
	Men (n=56)	Women (n=35)	P-value	SMD	Men (n=35)	Women (n=35)	P-value	SMD
Operation time, min	255 [220; 300]	240 [210; 330]	0.711	-0.016	272 [255;300]	240 [210;330]	0.812	-0.058
Cardiopulmonary bypass time, min	117 [99.5; 152.5]	115 [92; 145]	0.390	-0.153	125 [113;151]	115 [92;145]	0.908	-0.027
Cardioplegic arrest time, min	81.5 [72.5; 102.5]	78.5 [65; 115]	0.460	-0.020	81 [74; 100]	78.5 [65;115]	0.949	0.014
Lower body circulatory arrest, min	15 [14; 18]	15 [13; 18]	0.346	-0.227	15 [14;17]	15 [13;18]	0.596	-0.113
Cerebral perfusion time, min	15 [14; 18]	15.5 [14; 18]	0.993	-0.032	15.2 [15;18]	15.5 [14;18]	0.901	-0.027
Lowest temperature, °C	28 [26; 30]	27 [25; 29]	0.089	-0.390	27 [26;29]	27 [25;29]	0.431	-0.053
Supracommissural aortic replacement, n (%)	52 (92.8%)	33 (94.3%)	0.789	0.061	33 (94.3%)	33 (94.3%)	> 0.999	0.001
Bentall procedure, n (%)	1 (1.8%)	0	0.426	0.018	0	0	> 0.999	0.001
Aortic valve reimplantation (David technique), n (%)	3 (5.4%)	2 (5.7%)	0.942	0.015	2 (5.7%)	2 (5.7%)	> 0.999	0.001
CABG, n (%)	9 (16.1%)	4 (11.4%)	0.538	-0.144	5 (14.2%)	4 (11.4%)	0.553	0.001
AVR, n (%)	14 (25%)	9 (25.7%)	0.866	0.036	7 (20%)	9 (25.7%)	0.456	0.001

Variable	Before matching				After matching
	Men (n=56)	Women (n=35)	P-value	SMD	Men (n=35)	Women (n=35)	P-value	SMD
ICU stay, days	2 [2; 3]	2 [2; 6]	0.720	0.328	2 [2;3]	2 [2;6]	0.701	0.241
Invasive ventilation time, hours	13 [10; 20]	13.2 [10; 27]	0.542	0.362	13.1 [10; 20]	13.2 [10;27]	0.622	0.310
TND, n (%)	0	1 (2.9%)	0.203	0.169	0	1 (2.9%)	0.257	0.169
Stroke, n (%)	1 (1.8%)	0	0.426	-0.104	0	0	> 0.999	0.001
Delirium, n (%)	0	0	> 0.999	0.001	0	0	> 0.999	0.001
Respiratory failure, n (%)	2 (3.6%)	5 (14.3%)	0.059	0.302	2 (5.7%)	5 (14.3%)	0.235	0.241
Chest tube output, ml	300 [200; 400]	315 [200; 500]	0.605	0.143	308 [200; 400]	315 [200; 400]	0.723	0.078
Reoperation for bleeding, n (%)	0	2 (5.7%)	0.070	0.243	0	2 (5.7%)	0.154	0.243
Renal replacement therapy, n (%)	1 (1.8%)	2 (5.7%)	0.307	0.243	1 (2.9%)	2 (5.7%)	0.553	0.243
Myocardial infarction, n (%)	0	0	> 0.999	-0.142	0	0	> 0.999	-0.121
Mediastinitis, n (%)	1 (1.8%)	0	0.426	0.152	0	0	> 0.999	0.165
Multiple organ failure, n (%)	1 (1.8%)	1 (2.9%)	0.734	0.063	1 (2.9%)	1 (2.9%)	> 0.999	0.001
In-hospital mortality, n (%)	1 (1.8%)	2 (5.7%)	0.307	0.167	1 (2.9%)	2 (5.7%)	0.553	0.121

Sociedade Brasileira de Cirurgia Cardiovascular Rua Afonso Celso, 1178 Vila Mariana, CEP: 04119-061 - São Paulo/SP Brazil, Tel +55 (11) 3849-0341, Tel +55 (11) 5096-0079 - São Paulo - SP - Brazil
E-mail: bjcvs@sbccv.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Correspondence Address: Dmitri Panfilov, https://orcid.org/0000-0003-2201-350X, Cardiovascular Department, Cardiology Research Institute, Tomsk National Research Medical Center, Kievskaya st, 111a, Tomsk, Russian Federation, Zip Code: 634012, E-mail: pand2006@yandex.ru