Abstract 16022: Is Proximal Aortic Repair Sufficient for Autoimmune Aortitis?
OBJECTIVES: Autoimmune aortitis is an under-recognized cause of ascending aorta disease requiring surgery. Little is known about surgical outcomes and natural history thereafter. Objectives of this study were to characterize surgical patients and assess early and late outcomes.
Methods: From 1996 to 2012, 7,551 patients underwent ascending aorta surgery, 156 (2%) were pathologically proven to have aortitis. Mean age was 66±14 years, and 64% were women. Mean maximum preoperative diameters were 54±11 mm in the ascending aorta and 41±15 mm in the descending aorta. Indications for surgery were degenerative aneurysm (n= 132), acute aortic syndrome (n=15), aortic rupture (n=2) and chronic dissection (n=8). Surgical resection extended beyond the ascending aorta in 64% and Stage I elephant trunk (ET) was performed in 47 patients. Concomitant cardiovascular procedures included aortic valve replacement (n=65), aortic valve repair (n= 21) and CABG (n=27). Mean follow-up was 4.3±3.2 years.
RESULTS: Aortitis was classified as giant cell (n=49), Takayasu (n=8), isolated aortitis (n=92), and aortitis due to other systemic disease (n=7). Diagnosis was made preoperatively in 18% and postoperatively in 82%. Operative mortality was 3%, and prevalence of stroke 1.9%, dialysis 1.9%, and reoperation for bleeding 5.1%. Postoperative immunosuppressant medications were used in 56 patients, 15 of whom underwent re-intervention. Freedom from death and re-intervention at 1, 5 and 8 years was 76.6%, 58.8% and 40.2 %.( Figure). There were no significant differences in survival and aortic re-intervention among aortitis groups.
Conclusion: Autoimmune aortitis is most often diagnosed by postoperative histology, and distal aortic involvement is common at presentation. Despite good surgical outcomes, risk of aortic reoperation is high. Prophylactic ET construction should be considered during ascending aorta repair, and close imaging follow-up is recommended.
- © 2013 by American Heart Association, Inc.