Outcomes 
Operative Mortality & Morbidity
"Elective" vs. "Emergency" Aortic Surgery
Operations on the aorta may be performed electively or as emergency surgery. Of those done electively, surgery may be performed 1) to prevent a problem from occurring, or 2) to improve symptoms.
Elective Surgery
Patients who undergo elective aortic surgery at the Aortic Surgery Program can expect excellent outcomes immediately after surgery and in the long term. At this center, the risk of death or complications is exceptionally low. Operative outcomes at this center include the following.
All Aortic root replacement (emergency+elective)11.Open distal anastomosis in aortic root replacement using axillary cannulation and moderate hypothermia. - Takayama H; Smith CR; Bowdish ME; Stewart AS - J Thorac Cardiovasc Surg - 01-JUN-2009; 137(6): 1450-3.
Mortality: 3.7%
All complications: 12%
(including respiratory failure, wound infection, pericardial effusion (fluid around the heart), stroke, or need for pacemaker)
In patients of all ages, outcomes for aortic root surgery using axillary cannulation are excellent.22. Aortic Root Surgery Performed through Axillary Cannulation in Septuagenarians and Octogenarians. Iribarne, A. Presented at the AATS Aortic Symposium in April 2010; currently in press.
1-year all cause mortality in patients under age 70: 4.2%
1-year mortality all cause in patients aged 70-80: 7.4%
1-year mortality all cause patients over age 80: 12.9%
Aortic root and valve replacement using First Generation Columbia Bioroot33. Modified Bentall operation with bioprosthetic valved conduit: Columbia University experience. Tabata M; Takayama H; Bowdish ME; Smith CR; Stewart AS - Ann Thorac Surg - 01-JUN-2009; 87(6): 1969-70.
Operative mortality: 2.9%
Aortic root and valve replacement using Second Generation Columbia Bioroot44. Modified Bentall operation with a novel biologic valved conduit. Stewart AS; Takayama H; Smith CR - Ann Thorac Surg - 01-MAR-2010; 89(3): 938-41.
Operative mortality: 2.0%
Stroke: 0
Valve-sparing aortic root replacement55. Safety of Valve-sparing Aortic Root Surgery in Septuagenarians and Octogenarians. Iribarne, A. Presented at the AATS Aortic Symposium in April 2010; currently in press.
Operative mortality in all patients: 0
1-year mortality in patients under age 70: 0
1-year mortality in patients aged 70-80: 6.7%
1-year mortality in patients over age 80: 15.8%
Total aortic arch reconstruction using hybrid endovascular approach, without hypothermic circulatory arrest66. Use of carotid-subclavian arterial bypass and thoracic endovascular aortic repair to minimize cerebral ischemia in total aortic arch reconstruction. - Xydas S, Wei B, Takayama H, Russo M, Bacchetta, Smith CR, Stewart AS. - J Thorac Cardiovasc Surg - 01-MAR-2010; 139(3): 717-22; discussion 722.
mortality: 11%
Total aortic arch reconstruction using hybrid endovascular approach, with hypothermic circulatory arrest:
mortality: 18%
Emergency Surgery
Acute Type A Dissection77. Acute Type A Dissection - Changes in Approach.Yang, JA, Scully, BF, Stewart, A. Presented at the AATS Aortic Symposium in April 2010; currently in press.
Traditionally, emergency surgery in patients with acute Type A aortic dissection has been associated with significant risk. At this center, we previously repaired Type A dissections using traditional surgical methods, which included profound hypothermic circulatory arrest. Beginning in 2008, we altered our strategy to use antegrade selective perfusion, mild hypothermia, and full aortic root replacement. This change has significantly improved surgical outcomes:
| Before 2008 | After 2008 | |
|---|---|---|
| Risk of death: | 20% | 0 |
| Risk of stroke: | 7% | 0 |
Acute aortic dissection with repair using Generation I Columbia Bioroot88. Modified Bentall operation with bioprosthetic valved conduit: Columbia University experience. Tabata M; Takayama H; Bowdish ME; Smith CR; Stewart AS - Ann Thorac Surg - 01-JUN-2009; 87(6): 1969-70.
Operative mortality: 2.9% (patients with acute aortic dissection)
- Open distal anastomosis in aortic root replacement using axillary cannulation and moderate hypothermia. - Takayama H; Smith CR; Bowdish ME; Stewart AS - J Thorac Cardiovasc Surg - 01-JUN-2009; 137(6): 1450-3.
- Aortic Root Surgery Performed through Axillary Cannulation in Septuagenarians and Octogenarians. Iribarne, A. Presented at the AATS Aortic Symposium in April 2010; currently in press.
- Modified Bentall operation with bioprosthetic valved conduit: Columbia University experience. Tabata M; Takayama H; Bowdish ME; Smith CR; Stewart AS - Ann Thorac Surg - 01-JUN-2009; 87(6): 1969-70.
- Modified Bentall operation with a novel biologic valved conduit. Stewart AS; Takayama H; Smith CR - Ann Thorac Surg - 01-MAR-2010; 89(3): 938-41.
- Safety of Valve-sparing Aortic Root Surgery in Septuagenarians and Octogenarians. Iribarne, A. Presented at the AATS Aortic Symposium in April 2010; currently in press.
- Use of carotid-subclavian arterial bypass and thoracic endovascular aortic repair to minimize cerebral ischemia in total aortic arch reconstruction. - Xydas S, Wei B, Takayama H, Russo M, Bacchetta, Smith CR, Stewart AS. - J Thorac Cardiovasc Surg - 01-MAR-2010; 139(3): 717-22; discussion 722.
- Acute Type A Dissection - Changes in Approach.Yang, JA, Scully, BF, Stewart, A. Presented at the AATS Aortic Symposium in April 2010; currently in press.
- Modified Bentall operation with bioprosthetic valved conduit: Columbia University experience. Tabata M; Takayama H; Bowdish ME; Smith CR; Stewart AS - Ann Thorac Surg - 01-JUN-2009; 87(6): 1969-70.
