Probability of Uneventful Recovery After Elective Aortic Root Replacement for Aortic Aneurysm

Background: Little is known about the chance of patients not experiencing complications (uneventful recovery) after aortic root replacement for aortic aneurysm. The aim of this study was to investigate the probability of uneventful recovery, identify its predictors, and address the association between the uneventful recovery and long-term survival.

Methods: Patients with aortic aneurysm who underwent elective aortic root replacement between 2005 and 2018 were retrospectively reviewed (N = 676). Uneventful recovery was defined as avoidance of all of the following complications during the index hospital stay (selected based on Cox proportional hazards regression for long-term survival): mortality, any stroke, reexploration for bleeding, respiratory failure, acute renal failure, deep sternal infection, and postcardiotomy shock. Permanent pacemaker implantation was included because of its clinical perspectives. Patients were divided into 4 different age groups (group <60 years of age, n = 299; group 60-69 years of age, n = 209; group 70-79 years of age, n = 125; group ≥80 years of age, n = 43), according to a restricted cubic spline analysis on in-hospital mortality and postoperative stroke.

Results: Uneventful recovery was 78.1%. The probability of uneventful recovery decreased in a linear fashion as the age increases (82.6% in the group <60 years of age, 79.0% in the group 60-69 years of age, 70.4% in the group 70-79 years of age, 65.1% in the group ≥80 years of age; P = .007). A multivariable logistic regression showed age, left ventricular ejection fraction, previous cardiac surgery, and peripheral artery disease were independent predictors of uneventful recovery. Uneventful recovery resulted in significantly better 5-year survival (log-rank P = .039).

Conclusions: This study provides novel information regarding the probability of uneventful recovery while confirming low in-hospital mortality and stroke rates after elective aortic root replacement for aortic aneurysm. Importantly, uneventful recovery ensures excellent long-term survival.