Aortic aneurysms and dissections. A clinical follow-up after surgery
Sammanfattning: ABSTRACTThe purpose of this study was to report on the results after aortic surgery on thoracic aneurysms and dissections and to study the feasibility of magnetic resonance imaging (MRI) in the follow-up after aortic surgery. In this thesis, 203 patients ungergoing surgery on the thoracic aorta between 1977 and 2000 are included. Early and late mortality, morbidity and the functional status of surviving patients were investigated. In Study I, 126 patients undergoing surgery on the ascending aorta with a composite graft were included and, in Study II, 42 patients who underwent replacement of the aortic arch were evaluated. In Study III, 15 high-risk patients treated with a new, less invasive surgical procedure were included. An endovascular stent-graft was used to treat aneurysms, dissections and infections in the descending aorta. In Study IV, 74 patients with Marfan syn-drome who underwent different operations on the thoracic aorta were included. In Study V, 27 patients with a composite graft in the ascending aorta were checked using MRI. Follow-up in all studies was 100% complete in terms of survival and morbidity. Functional status was obtained from questionnaires or telephone interviews. Hospital mortality in elective surgery on the ascending aorta was 10%, while it was 18% for surgery on the aortic arch. In acute cases, hospital mortality was 29% for patients undergoing surgery on the ascending aorta and 60% for patients undergoing surgery on the aortic arch. Five- and 10-year survival after surgery on the ascending aorta was 67% and 48% respecti-vely, while it was 44% and 36% respectively on the aortic arch. In both studies, acute surgery was a risk factor for early mortality and age at operation was a risk factor for late mortality. All the 15 high-risk patients treated with endovascular stent-grafts survived the procedure. The morbi-dity was low: one endoleak required a new procedure and one patient had a stroke with perma-nent hemiplegia. One patient died during the follow-up period (mean 10 months).Hospital mortality in patients with Marfan syndrome was 3% in elective surgery and 19% in acute. Five- and 10-year survival after surgery was 79% and 63% respectively. The long-term functional status after surgery in patients with Marfan syndrome was satisfactory, with 98% of the patients in NYHA class I or II.All the composite grafts could be demonstrated by MRI. The aortic valves produced a mode-rate artefact in the images. In eight patients, previously unknown pathology of the remaining aorta was detected (seven dissections, one aneurysm). Patients with aortic aneurysms should be operated on at an early stage and electively to reduce early complications. Aneurysms and dissections of the aorta have a high risk for relapse, which calls for careful follow-up. Selected cases with aneurysms and dissections in the descending aorta may be treated with endovascular stent-grafts. MRI may be used in the follow-up of aortic root surgery.
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