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Lampridou S, Saghdaoui LB, Bicknell C, Kumlien C, Lear R. Health Related Quality of Life Following Intervention for Thoracoabdominal Aortic Aneurysm: A Systematic Review and Narrative Synthesis. Ann Vasc Surg 2024; 101:105-119. [PMID: 38160705 DOI: 10.1016/j.avsg.2023.10.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/25/2023] [Accepted: 10/26/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Thoracoabdominal aortic aneurysms (TAAA) pose significant risks of morbidity and mortality. Considering the evolving techniques for TAAA intervention and the growing interest in quality of life (QoL) outcomes for decision-making, we aimed to evaluate the impact of patient and perioperative characteristics on short-term, medium-term, and long-term postoperative QoL in TAAA repair patients. METHODS A systematic search was conducted in CINAHL, APA PsycINFO, EMBASE, Medline and Cochrane to identify primary research studies evaluating QoL post TAAA surgery, published in English or Swedish between January 01, 2012 and September 26, 2022. A narrative synthesis was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The quality of evidence was assessed using the Critical Appraisal Skills Program and Joanna Briggs Institute checklists. RESULTS Eight studies of low or moderate quality with 455 patients were included. Preoperative QoL in TAAA patients was lower compared to the general population. While there is an initial short-term improvement in postoperative QoL, patients fail to reach baseline levels even after 7 years, with physical activity and functioning domains being particularly affected. Experiencing postoperative complications, including paraplegia and cardiovascular events, negatively impacts postoperative QoL. Patients with uncomplicated postoperative status had improved QoL. Prolonged hospital stay negatively affects physical functioning. CONCLUSIONS Individuals with TAAA are likely to have lower baseline QoL compared to the general population. Following TAAA repair, postoperative QoL may remain lower than baseline levels, persisting over the long-term. Comorbidities, postoperative complications, and hospitalization duration appear to exert adverse effects on postoperative QoL.
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Affiliation(s)
- Smaragda Lampridou
- Vascular Surgery Department, Imperial College Healthcare NHS Trust, London, UK; Faculty of Medicine, Department of Surgery & Cancer, Imperial College London, London, UK.
| | - Layla Bolton Saghdaoui
- Vascular Surgery Department, Imperial College Healthcare NHS Trust, London, UK; Faculty of Medicine, Department of Surgery & Cancer, Imperial College London, London, UK
| | - Colin Bicknell
- Vascular Surgery Department, Imperial College Healthcare NHS Trust, London, UK; Faculty of Medicine, Department of Surgery & Cancer, Imperial College London, London, UK
| | - Christine Kumlien
- Department of Care Science, Malmö University, Malmö, Sweden; Department of Cardiothoracic and Vascular Surgery, Skåne University Hospital, Malmö, Sweden
| | - Rachael Lear
- Institute of Global Health Innovation, NIHR Imperial Biomedical Research Centre, Imperial College London, London, UK
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Hamiko M, Jahnel K, Rogaczewski J, Schafigh M, Silaschi M, Spaeth A, Velten M, Roell W, Ahmad AES, Bakhtiary F. The Long-Term Outcome and Quality of Life after Replacement of the Ascending Aorta. J Clin Med 2023; 12:4498. [PMID: 37445533 DOI: 10.3390/jcm12134498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/26/2023] [Accepted: 07/03/2023] [Indexed: 07/15/2023] Open
Abstract
(1) Background: Despite optimal surgical therapy, replacement of the ascending aorta leads to a significant reduction in the quality of life (QoL). However, an optimal result includes maintaining and improving the QoL. The aim of our study was to evaluate the long-term outcome and the QoL in patients with aneurysms in the ascending aorta; (2) Methods: Between 2014 and 2020, 121 consecutive patients who underwent replacement of the ascending aorta were included in this study. Acute aortic pathologies were excluded. A standard short form (SF)-36 questionnaire was sent to the 112 survivors. According to the surgical procedure, patients were divided into two groups (A: supracoronary replacement of the aorta, n = 35 and B: Wheat-, David- or Bentall-procedures, n = 86). The QoL was compared within these groups and to the normal population, including myocardial infarction (MI), coronary artery disease (CAD) and cancer (CAN) patients; (3) Results: 83 patients were males (68.6%) with a mean age of 62.0 ± 12.5 years. Early postoperative outcomes showed comparable results between groups A and B, with a higher re-thoracotomy rate in B (A: 0.0% vs. B: 22.1%, p = 0.002). The 30-day mortality was zero. Overall, mortality during the follow-up was 7.4%. The SF-36 showed a significant decay in both the Physical (PCS) and Mental Component Summary (MCS) in comparison to the normal population (PCS: 41.1 vs. 48.4, p < 0.001; MCS: 42.1 vs. 50.9, p < 0.001) but without significant difference between both groups. Compared to the MI and CAD patients, significantly higher PCS but lower MCS scores were detected (p < 0.05); (4) Conclusions: Replacement of the ascending aorta shows low risk regarding the operative and postoperative outcomes with satisfying long-term results in the QoL. The extent of the surgical procedure does not influence the postoperative QoL.
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Affiliation(s)
- Marwan Hamiko
- Department of Cardiac Surgery, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Katja Jahnel
- Department of Cardiac Surgery, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Julia Rogaczewski
- Department of Cardiac Surgery, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Myriam Schafigh
- Department of Cardiac Surgery, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Miriam Silaschi
- Department of Cardiac Surgery, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Andre Spaeth
- Department of Cardiac Surgery, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Markus Velten
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Wilhelm Roell
- Department of Cardiac Surgery, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Ali El-Sayed Ahmad
- Department of Cardiac Surgery, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Farhad Bakhtiary
- Department of Cardiac Surgery, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
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Ilonzo N, Taubenfeld E, Yousif MD, Henoud C, Howitt J, Wohlauer M, D'Oria M, MacCarrick G. The Mental Health Impact of Aortic Dissection. Semin Vasc Surg 2022; 35:88-99. [DOI: 10.1053/j.semvascsurg.2022.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/07/2022] [Accepted: 02/10/2022] [Indexed: 11/11/2022]
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Bi Y, Yi M, Han X, Ren J. Clinical outcomes and quality of life in patients with acute and subacute type B aortic dissection after thoracic endovascular aortic repair. J Int Med Res 2020; 48:300060520945506. [PMID: 32776820 PMCID: PMC7418244 DOI: 10.1177/0300060520945506] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective Thoracic endovascular aortic repair (TEVAR) is considered the mini-invasive treatment of choice for patients with Stanford type B aortic dissection (TBAD). This study aimed to investigate the clinical outcomes and quality of life (QoL) in patients with acute and subacute TBAD after TEVAR. Methods From January 2014 until July 2016, 22 acute patients (Group A) and 18 subacute patients received TEVAR (Group B), and 13 patients were managed non-operatively (Group C). The Medical Outcomes Study Short Form-36 was used to assess QoL preoperatively and after TEVAR. Operative techniques and complications were retrospectively analyzed. Results The role emotion, vitality, and mental health domains scored well preoperatively. Except for role emotion, vitality, and mental health, the remaining domains significantly improved after TEVAR. There was no significant difference in QoL metrics between Groups A and B. In Group C, bodily pain and social functioning domains were improved, and role emotion was decreased, with no improvement in the remaining domains. The 3-year survival rates were 95.5%, 100%, and 85.7% for Groups A, B, and C, respectively. Conclusions TEVAR may be safe and effective in patients with acute and subacute TBAD with similar and favorable clinical and QoL metrics.
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Affiliation(s)
- Yonghua Bi
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mengfei Yi
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xinwei Han
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jianzhuang Ren
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Gökalp AL, de Heer F, Etnel JRG, Kluin J, Takkenberg JJM. Clinical and quality of life outcomes after aortic valve replacement and aortic root surgery in adult patients <65 years old. Ann Cardiothorac Surg 2019; 8:372-382. [PMID: 31240181 DOI: 10.21037/acs.2019.04.07] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Selecting the optimal surgical treatment strategy in patients below the age of 65 years (i.e., non-elderly patients) with aortic valve or aortic root disease remains challenging. The objective of the current study is to summarize contemporary research on clinical and quality of life outcomes after aortic valve replacement (AVR) and aortic root surgery in non-elderly patients. Recent systematic reviews on clinical outcome after biological and mechanical AVR, the Ross procedure and aortic root surgery show that event occurrence is considerable after any type of AVR or aortic root surgery and-with the exception of the Ross procedure-survival is suboptimal. Although thromboembolism and bleeding events are more common after mechanical AVR and root surgery, these events are also considerably present after biological AVR, the Ross procedure and valve-sparing aortic root surgery (VSRR). Similarly, reoperation is more common after biological AVR, the Ross procedure and VSRR, but also occurs frequently after mechanical AVR and root replacement. Published evidence in AVR patients points to the direction of better health-related quality of life (HRQoL) outcomes with a biological solutions, while the HRQoL after aortic root surgery is limited and contradictory. This review illustrates that treatment for non-elderly aortic valve and aortic root disease patients needs to be tailored to the individual patient, considering both clinical and HRQoL outcomes as crucial factors to reach a treatment decision that best reflects the patient's values and goals in life.
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Affiliation(s)
- Arjen L Gökalp
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Jonathan R G Etnel
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jolanda Kluin
- Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Johanna J M Takkenberg
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
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Gökalp AL, Takkenberg JJ. Decision-Making in Thoracic Aortic Aneurysm Surgery—Clinician and Patient View. Semin Thorac Cardiovasc Surg 2019; 31:638-642. [DOI: 10.1053/j.semtcvs.2019.05.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 05/12/2019] [Indexed: 01/16/2023]
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7
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Open versus Endovascular Repair of Descending Thoracic Aortic Aneurysm Disease: A Systematic Review and Meta-analysis. Ann Vasc Surg 2019; 54:304-315.e5. [DOI: 10.1016/j.avsg.2018.05.043] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 05/21/2018] [Accepted: 05/23/2018] [Indexed: 01/09/2023]
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de Heer F, Gökalp AL, Kluin J, Takkenberg JJM. Measuring what matters to the patient: health related quality of life after aortic valve and thoracic aortic surgery. Gen Thorac Cardiovasc Surg 2019; 67:37-43. [PMID: 28905303 PMCID: PMC6323078 DOI: 10.1007/s11748-017-0830-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 09/03/2017] [Indexed: 01/22/2023]
Abstract
With improved outcomes following cardiac surgery, health related quality of life (HRQoL) gains increasing importance for the better judgement of choosing the preferred treatment strategy in the individual patient. The physician perception of patient preferences can differ considerably from actual patient preferences, underlining the importance of gathering evidence of actual patient preferences before and quality of life after cardiac surgery. The objective of the current review is to provide an overview of current insights into the quality of life measurements after aortic valve and thoracic aortic surgery and to provide starting points for the application of HRQoL measurements toward the future. The amount and level of evidence on HRQoL outcomes after aortic valve and thoracic aortic surgery seems to be insufficient. Little has been investigated about the natural course of HRQoL after cardiac surgery, HRQoL outcomes between different surgical strategies, HRQoL outcomes between surgical patients and the general population, the different factors influencing HRQoL after cardiac surgery, and the effect of HRQoL on healthcare costs. More prospective studies should be performed, taking into account the knowledge gaps that need to be filled. Computerized adaptive testing methods through open source programs can be implemented to keep the burden to the patient as low as possible and catalyze the use of these tools. Our cardiovascular surgery community has the responsibility to deliberate how it can proceed to effectively fill in these knowledge gaps, and use this newfound knowledge to improve shared treatment decision making, patient outcomes, and ultimately optimize health care efficiency.
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Affiliation(s)
- Frederiek de Heer
- Dept. of Cardio-Thoracic Surgery, Academic Medical Center, P.O. Box 22660, 1105 AZ, Amsterdam, The Netherlands
| | - Arjen L Gökalp
- Dept. of Cardio-Thoracic Surgery, Academic Medical Center, P.O. Box 22660, 1105 AZ, Amsterdam, The Netherlands
| | - Jolanda Kluin
- Dept. of Cardio-Thoracic Surgery, Academic Medical Center, P.O. Box 22660, 1105 AZ, Amsterdam, The Netherlands
| | - Johanna J M Takkenberg
- Dept. of Cardio-Thoracic Surgery, Bd563, Erasmus University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
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Jarral OA, Kidher E, Patel VM, Nguyen B, Pepper J, Athanasiou T. Quality of life after intervention on the thoracic aorta. Eur J Cardiothorac Surg 2015; 49:369-89. [DOI: 10.1093/ejcts/ezv119] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 02/24/2015] [Indexed: 12/24/2022] Open
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Okamoto Y, Motomura N, Murashima S, Takamoto S. Anxiety and depression after thoracic aortic surgery or coronary artery bypass. Asian Cardiovasc Thorac Ann 2013; 21:22-30. [PMID: 23430416 DOI: 10.1177/0218492312444283] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND although the outcome of thoracic aortic surgery has improved remarkably, mortality remains high, and mental distress is often present. Psychological outcomes of coronary artery disease have been increasingly researched but few studies have been conducted in thoracic aortic surgery patients. OBJECTIVE to compare the psychological outcomes of patients undergoing thoracic aortic surgery with those of patients undergoing coronary artery bypass grafting. METHODS a questionnaire was mailed to 190 patients who underwent thoracic aortic surgery or coronary artery bypass, at 1-5 years postoperatively. Psychological outcomes were assessed using the hospital anxiety and depression scale. RESULTS 128 patients responded; 49 had aortic surgery and 79 had coronary artery bypass. The incidence of borderline or significant anxiety was 14% in thoracic aortic surgery patients and 16% in coronary bypass patients; depression was present in 28% and 20%, respectively. Psychological outcome scores in the 2 groups did not differ significantly. Emergency surgery was associated with depression after aortic surgery, and symptoms such as chest pain and fatigue were associated with both anxiety and depression after coronary artery bypass. CONCLUSIONS some psychological problems remain in the midterm following thoracic aortic surgery. While we expected a more psychologically compromised outcome in the thoracic aortic surgery group, psychological outcomes were quite similar to those in coronary artery bypass patients. The similarity of the profiles of both groups suggests that thoracic aortic surgery patients have a parallel course of midterm psychological improvement following surgery.
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Affiliation(s)
- Yuko Okamoto
- Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Olsson C, Franco-Cereceda A. Health-Related Quality of Life in Thoracic Aortic Disease: Part I. Cases Managed Non-operatively. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2013; 1:153-61. [PMID: 26798688 DOI: 10.12945/j.aorta.2013.13-028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 07/12/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND The health-related quality of life (HRQOL) in subjects with chronic thoracic aortic disease (TAD) not scheduled for intervention has not been previously reported. Such information may aid counseling, management, and clinical decision-making. We report HRQOL in TAD, its main subtypes (aneurysm versus dissection and proximal versus distal), compare it to a reference group from the general population, and explore independent predictors. METHODS The short-form 36-item (SF-36) questionnaire was used, as part of a self-reporting health survey, to measure HRQOL in eight domains and a physical component summary (PCS) and a mental component summary (MCS) score. Median differences (Δ) between the component summary scores and a sex- and age-matched reference group from the general population were the primary outcome measures. Multivariable techniques were used to evaluate independent predictors. RESULTS In 178 TAD subjects, the HRQOL was reduced (versus the reference group) in the PCS, Δ -6.4 [95% confidence limits -8.8, -4.0] and in three out of eight SF-36 domains: physical functioning (PF), Δ -10 [-15, -4.5]; physical role (RP), Δ -25 [-34, -16]; general health (GH), Δ -5.0 [-9.7, -0.27]. There were no statistically significant differences in HRQOL scores in type (aneurysm versus dissection) or location (proximal versus distal) of TAD. Multivariable analyses identified symptoms of exertional dyspnea, exertional calf pain, joint pain, and angina pectoris as predictors of lower SF-36 component summary scores. CONCLUSIONS The HRQOL in subjects with chronic TAD is reduced compared to a matched reference group. Differences, however, are comparably small and limited to physical domains. There were no differences according to type or location of TAD. Present symptoms and conditions were influential on the physical and mental component summary scores. HRQOL could be a useful part of thoracic aortic disease surveillance and could help guide interventional decision-making.
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Affiliation(s)
- Christian Olsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; and Department of Cardiovascular Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Anders Franco-Cereceda
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; and Department of Cardiovascular Surgery, Karolinska University Hospital, Stockholm, Sweden
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Olsson C, Franco-Cereceda A. Health-Related Quality of Life in Thoracic Aortic Disease: Part II. After Surgery on the Proximal (Root, Ascending, Arch) Aorta. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2013; 1:162-70. [PMID: 26798689 DOI: 10.12945/j.aorta.2013.13-029] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 07/12/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Health-related quality of life (HRQOL) has been reported to be near-to-normal after operations on the proximal aorta. However, a thorough evaluation of variables related to postoperative HRQOL is lacking. We report HRQOL after surgery on the proximal aorta acknowledging current symptoms and conditions. If modifiable factors affect HRQOL, surgical treatment could be tailored to optimize outcomes. METHODS The short form 36 item (SF-36) questionnaire was used to measure HRQOL in eight domains and a physical component summary (PCS) and mental component summary (MCS) score. Median differences (Δ) between the component summary scores and a sex- and age-matched reference group from the general population were the primary outcome measures, along with comparisons of patient subgroups according to pathology (aneurysm versus dissection), aortic valve procedure, and circulatory arrest. RESULTS In 207 patients operated on the proximal aorta, after a mean of three years, there were no significant differences in median PCS (Δ = -0.3 [95% confidence limits -2.6, 2.0]) and MCS (Δ = 1.7 [-0.4, 2.9]) scores compared to the reference group, but median scores for the physical functioning, general health, and mental health domains were significantly lower. There were no statistically significant differences in PCS, MCS, or domain scores for patients with aneurysm versus dissection, for patients undergoing aortic valve procedures or not, or for patients managed with circulatory arrest or not. In multivariable analysis, exertional dyspnea was independently related to both ΔPCS (-6.5 [-13, -0.44]) and ΔMCS (-7.5 [-13, -1.6]), whereas age, exertional calf pain, and myocardial infarction were related only to ΔPCS. CONCLUSIONS Overall HRQOL after surgery on the proximal aorta is encouraging, which remains important when benchmarking against novel therapeutic procedures. At follow-up, HRQOL appears related to current symptoms and conditions, but not to operative procedures. To better understand their impact on HRQOL, prospective studies comparing pre- and postoperative scores are needed.
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Affiliation(s)
- Christian Olsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; and Department of Cardiovascular Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Anders Franco-Cereceda
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; and Department of Cardiovascular Surgery, Karolinska University Hospital, Stockholm, Sweden
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Jeremy RW. Thoracic aortic dissection - beyond the acute problem. Heart Lung Circ 2010; 19:641-3. [PMID: 20951338 DOI: 10.1016/s1443-9506(10)01480-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Should Aortas in Patients with Bicuspid Aortic Valve Really be Resected at an Earlier Stage than Tricuspid? PRO. Cardiol Clin 2010; 28:289-98. [DOI: 10.1016/j.ccl.2010.01.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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15
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Coroneos CJ, Mastracci TM, Barlas S, Cinà CS. The effect of thoracoabdominal aneurysm repair on quality of life. J Vasc Surg 2009; 50:251-5. [DOI: 10.1016/j.jvs.2009.01.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2008] [Revised: 12/23/2008] [Accepted: 01/03/2009] [Indexed: 10/20/2022]
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Crawford RS, Pedraza JD, Chung TK, Corey M, Conrad MF, Cambria RP. Functional outcome after thoracoabdominal aneurysm repair. J Vasc Surg 2008; 48:828-35. [DOI: 10.1016/j.jvs.2008.05.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2008] [Revised: 05/05/2008] [Accepted: 05/10/2008] [Indexed: 11/27/2022]
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Dick F, Hinder D, Immer FF, Hirzel C, Do DD, Carrel TP, Schmidli J. Outcome and quality of life after surgical and endovascular treatment of descending aortic lesions. Ann Thorac Surg 2008; 85:1605-12. [PMID: 18442547 DOI: 10.1016/j.athoracsur.2008.01.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2007] [Revised: 01/07/2008] [Accepted: 01/08/2008] [Indexed: 12/28/2022]
Abstract
BACKGROUND Thoracic endovascular aortic repair (TEVAR) represents an attractive alternative to open aortic repair (OAR). The aim of this study was to assess outcome and quality of life in patients treated either by TEVAR or OAR for diseased descending thoracic aorta. METHODS A post hoc analysis of a prospectively collected consecutive series of 136 patients presenting with surgical diseases of the descending aorta between January 2001 and December 2005 was conducted. Fourteen patients were excluded because of involvement of the ascending aorta. Assessed treatment cohorts were TEVAR (n = 52) and OAR (n = 70). Mean follow-up was 34 +/- 18 months. End points were perioperative and late mortality rates and long-term quality of life as assessed by the Short Form Health Survey (SF-36) and Hospital Anxiety and Depression Score questionnaires. RESULTS Mean age was significantly higher in TEVAR patients (69 +/- 10 years versus 62 +/- 15 years; p = 0.002). Perioperative mortality rates were 9% (OAR) and 8% (TEVAR), respectively (p = 0.254). Accordingly, cumulative long-term mortality rates were similar in both cohorts. Overall quality-of-life scores were 93 (63-110, OAR) and 83 (60-112, TEVAR), respectively. Normal quality-of-life scores range from 85 to 115. Anxiety and depression scores were not increased after open surgery. CONCLUSIONS Thoracic endovascular aortic repair and OAR both provide excellent long-term results in treatment of thoracic aortic disease. Long-term quality of life, however, is reduced after thoracic aortic repair. Interestingly, TEVAR patients did not score higher in overall quality of life despite all advantages of minimized access trauma. Similarly, anxiety and depression scores are not reduced by TEVAR, possibly reflecting a certain caution against the new technology.
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Affiliation(s)
- Florian Dick
- Department of Cardiovascular Surgery, Swiss Cardiovascular Centre, Inselspital, University Hospital Bern, and University of Bern, Bern, Switzerland
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Agarwal V, Yaliwal C, Ofo E, Kolvekar S. Giant ascending aortic aneurysm--a case report and review. Heart Lung Circ 2007; 16:385-8. [PMID: 17314066 DOI: 10.1016/j.hlc.2006.09.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2006] [Revised: 09/12/2006] [Accepted: 09/21/2006] [Indexed: 12/21/2022]
Abstract
We present a case report and review of the literature on a giant ascending aortic aneurysm in a previously asymptomatic and healthy 40-year-old male patient who presented in extremis and had a successful emergency surgical repair. The need for early referral and surgery is stressed for better outcome. The review also discusses the natural history, presentation and treatment options and results of this uncommon entity justifying the need for an operation for survival.
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Affiliation(s)
- Vijay Agarwal
- The Heart Hospital, Department of Cardiothoracic Surgery, University College of London Hospital NHS trust, 16 West Moreland Street, London, W1G 8PH, UK.
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Delis KT, Gloviczki P, Bjarnason H, Sullivan TM, McKusick MA, Kalra M, Bower TC. Endovascular Repair of Ruptured Saccular Aneurysms of the Descending Thoracic Aorta. J Vasc Interv Radiol 2006; 17:1527-33. [PMID: 16990474 DOI: 10.1097/01.rvi.0000235695.76762.3f] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Open repair of ruptured aneurysms of the descending thoracic aorta (DTA) is associated with early mortality rates of 20%-60% and severe morbidity rates exceeding 40%. The present report describes three octogenarian patients and one sexagenarian patient at poor surgical risk admitted with acutely ruptured saccular DTA aneurysms (two of four were anastomotic) unrelated to trauma or infection who underwent successful endovascular therapy, which involved the use of aortic endovascular cuffs in three cases. Mean intensive care unit and total hospital stay durations were 1.75 days (range, 1-4 d) and 6 days (range, 3-13 d), respectively. At 30 days, all patients were alive and free of repeat intervention, with aneurysm exclusion achieved in all cases but one, which featured a marginal type II endoleak. These data support endovascular therapy for ruptured saccular DTA aneurysms enabling short-term outcomes that otherwise would have been unrealistic.
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Affiliation(s)
- Konstantinos T Delis
- Division of Vascular Surgery, Gonda Vascular Center, Mayo Clinic, 200 First Street Southwest, Rochester, Minnesota 55905, USA
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Eide TMO, Romundstad P, Klepstad P, Myhre HO. Health-related quality of life in long term-survivors of thoracoabdominal aortic aneurysm repair. JOURNAL OF VASCULAR NURSING 2005; 23:88-94; quiz 95. [PMID: 16125632 DOI: 10.1016/j.jvn.2005.06.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2005] [Revised: 06/21/2005] [Accepted: 06/21/2005] [Indexed: 11/20/2022]
Abstract
The purpose was to assess health-related quality of life (HRQOL) in long-term survivors of thoracoabdominal aneurysm repair. Between 1983 and 2001, 43 patients underwent thoracoabdominal aneurysm repair. Long-term survivors (13) were investigated. Two were lost to follow-up. The mean follow-up period was 6.2 years. HRQOL was measured by Short Form (SF)-36, constructed of 36 items grouped into eight scales measuring physical functioning, role limitations caused by physical problems, bodily pain, general health perceptions, vitality, social functioning, role limitations caused by emotional problems, and mental health. Additional questions specific for vascular disease were ascribed. The patients' relatives received corresponding questions, responding on behalf of the patients. Patient data scores were compared with a selection of individuals from the general population. The patients' SF-36 scores were generally poorer than that of the healthy population in both physical and mental dimensions. Patients who had a complicated postoperative course generally scored lowest in physical dimensions. Comparing patients' scores with relatives scoring on behalf of the patients showed no statistical differences. According to disease-specific questions, impotence and pain were reported as major long-term postoperative problems. Patients with uncomplicated postoperative courses all reported improved health status (six) compared with the preoperative status, whereas five patients with complicated postoperative courses reported poorer health status. Nine of 11 patients experienced the same or improved HRQOL, and two patients reported reduced HRQOL after surgery. Ten of 11 patients evaluated the operation as successful. Although the sample size in this study is small, those who had postoperative complications or reported a decreased physical function in the years after surgery generally had low scores in almost all dimensions of the SF-36. When disease-specific questions were related to thoracoabdominal aneurysm surgery, most patients reported an acceptable HRQOL.
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Immer FF, Lippeck C, Barmettler H, Berdat PA, Eckstein FS, Kipfer B, Saner H, Schmidli J, Carrel TP. Improvement of quality of life after surgery on the thoracic aorta: effect of antegrade cerebral perfusion and short duration of deep hypothermic circulatory arrest. Circulation 2005; 110:II250-5. [PMID: 15364871 DOI: 10.1161/01.cir.0000138387.61103.a0] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND We have recently demonstrated that the use of deep hypothermic circulatory arrest (DHCA) during surgery for acute type A aortic dissections or thoracic aortic aneurysms adversely affect mid-term quality of life (QoL). The aim of this study is to assess the impact of DHCA duration and the potential effects of antegrade cerebral perfusion (ACP) on mid-term QoL. METHODS AND RESULTS Between January 1994 and December 2002, 363 patients underwent surgery of the thoracic aorta with the use of DHCA at our institution. One hundred seventy-six (48.5%) presented with acute type A dissections and 187 (51.5%) presented with aortic aneurysms. ACP was used in 41 (11.3%) cases. All in-hospital data were assessed and a follow-up was performed in all survivors after 2.4+/-1.2 years. QoL was analyzed with the Short-Form 36 Health Survey Questionnaire (SF-36). In-hospital mortality was 8.6%. In comparison with patients having undergone DHCA <20 minutes, averaged QoL score was significantly decreased in patients with DHCA between 20 and 34 minutes (95.6+/-12.8 versus 81.9+/-15.7; P<0.01) and >35 minutes (61.8+/-18.3; P<0.01). Averaged QoL score was significantly better with the use of ACP, independently of the duration of DHCA. CONCLUSIONS DHCA duration >20 minutes, and especially >35 minutes, adversely affects mid-term QoL in patients undergoing surgery of the thoracic aorta. The use of ACP, however, improved averaged QoL score at each time period and allows DHCA to be extended up to 30 minutes, without impairment in mid-term QoL.
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Affiliation(s)
- Franz F Immer
- Department of Cardiovascular Surgery, University Hospital, 3010 Berne, Switzerland.
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Glade GJ, Vahl AC, Wisselink W, Linsen MAM, Balm R. Mid-term Survival and Costs of Treatment of Patients with Descending Thoracic Aortic Aneurysms; Endovascular vs. Open Repair: a Case-control Study. Eur J Vasc Endovasc Surg 2005; 29:28-34. [PMID: 15570268 DOI: 10.1016/j.ejvs.2004.10.003] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To evaluate the results of open surgery or endovascular stent graft repair of descending thoracic aortic aneurysm (TAA). DESIGN, MATERIALS AND METHODS This is a retrospective multicenter study of 95 patients undergoing TAA repair (42 stent grafts, 53 open repair). The median age was 67 years. Post-operative complications, mid-term survival and costs were assessed. The results were pooled with data in the literature. RESULTS After a mean follow up of 26 months (open group) and 15 months (endovascular group) survival was similar for patients treated by either repair method. Post-operative pneumonia was more in the open group (p <0.02). The hospital costs of open treatment were 40% more than that of the endovascular procedure. Combining the present results with pooled data from the literature the peri-operative mortality and paraplegia rate was less in the endovascular group (p <0.05). CONCLUSIONS These retrospective data suggest that endografting of descending thoracic aneurysms can be performed with less peri-operative morbidity, at lower hospital costs, but with equal mid-term life expectancy, compared with open grafting.
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Affiliation(s)
- G J Glade
- Department of Surgery, Onze Lieve Vrouwe Gasthuis, 1090 HM Amsterdam, The Netherlands
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Oda K, Hata M, Kawatsu S, Adachi O, Yamaya K, Saiki Y, Sakurai M, Akasaka J, Iguchi A, Tabayashi K. Quality of life in elderly patients following thoracic aortic surgery. ACTA ACUST UNITED AC 2004; 52:515-23. [PMID: 15609643 DOI: 10.1007/s11748-004-0002-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE While early outcomes following thoracic aortic surgery are improving, the long-term quality of life in elderly patients following this procedure remains uncharacterized. Thus, the goal of this retrospective study was to investigate quality of life in elderly patients following thoracic aortic surgery in regard to age, urgency of operation, operative procedures, skin incision, selective cerebral perfusion (SCP) time, and cardiopulmonary bypass time. METHODS One hundred-and-eleven surviving patients that underwent thoracic aortic surgery between 1987 and 1999 were enrolled in this study. The Short Form-36 (SF-36) health questionnaire was administered to all participants. RESULTS Some measures of quality of life were lower in those patients that underwent the procedure as compared to age- and gender-matched normal population. Quality of life (QOL) of the elderly patients with prolonged SCP time (>120 minutes) was significantly lower in the dimension of role-physical of SF-36. On the other hand, there was no significant difference between the subgroups in terms of urgency of operation, operative procedure, skin incision, and cardiopulmonary bypass time. CONCLUSIONS Physical and mental quality of life was significantly lower in elderly patients undergoing thoracic aortic surgery. Prolonged SCP time (>120 minutes) was a negative factor for long-term QOL. We advocate discussing the data with patients when obtaining informed consent for this procedure.
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Affiliation(s)
- Katsuhiko Oda
- Department of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
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Immer FF, Barmettler H, Berdat PA, Immer-Bansi AS, Englberger L, Krähenbühl ES, Carrel TP. Effects of deep hypothermic circulatory arrest on outcome after resection of ascending aortic aneurysm. Ann Thorac Surg 2002; 74:422-5. [PMID: 12173823 DOI: 10.1016/s0003-4975(02)03697-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Aneurysm of the ascending aorta is a common finding especially in patients with aortic valve diseases. The aim of this study was to analyze early and midterm outcome in patients operated on for aneurysm of the ascending aorta with or without the use of deep hypothermic circulatory arrest (DHCA). METHODS Between January 1996 and December 2000, 133 of 410 patients with thoracic aortic pathology were operated on for an aortic aneurysm limited mainly to the ascending aorta. Early and midterm outcomes were assessed and quality of life (QOL) evaluated using the Short-Form 36 Health Survey Questionnaire (SF-36). RESULTS Sixty patients (group 1) were operated on with DHCA and 73 patients (group 2) without DHCA. In-hospital mortality was identical in both groups (9.6% versus 6.7%; p = not significant) whereas postoperative transient neurologic events were significantly more frequent in group 1 (6.7% versus 0%; p < 0.05). Midterm clinical outcome was not different between groups but QOL showed significant impairment in daily functional physical and emotional activity in group 1 patients compared with group 2 and an age-matched standard population. CONCLUSIONS The risk of transient neurologic complications is significantly increased with the use of DHCA and QOL is impaired without benefits in the long-term outcome especially among older patients.
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Affiliation(s)
- Franz F Immer
- Department of Cardiovascular Surgery, University Hospital, Berne, Switzerland.
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