Long-Term Outcome and Quality of Life after Replacement of the Ascending Aorta

Background: Aortic aneurysms are generalized and affect the entire aorta. Treatment of aneurysms of the ascending aorta (AA) is therefore only a partial solution to the problem since further progression can occur in other parts of the aorta. Despite optimal therapy, this leads to a significant reduction in the quality of life (QoL). However, an optimal result of surgical therapy also includes maintaining and improving the QoL. To optimize the therapy, we conducted a survey on the postoperative QoL in patients with treated aortic aneurysms at our clinic.

Method: From January 2014 until January 2020, a total of 121 consecutive patients underwent replacement of the AA were included in this study. Standard short-form (SF)-36 and general health questionnaires were sent to the 112 survivors who could be traced. Early and long-term postoperative outcome were evaluated. According to the surgical procedure, patients were divided in two groups (A: supracoronary replacement of the ascending aorta, n = 35; B: Wheat, David, or Bentall procedures; n = 86). QoL was compared within the groups and with the normal healthy population (NP), myocardial infarction (MI), coronary artery disease (CAD), and cancer (CAN) patients.

Results: Of the total number of patients, 83 were males (68.6%) and 38 were females (31.4%); mean age was 62.0 ± 12.5 years with a mean follow-up (FU) of 45.1 ± 22.0 months. Baseline characteristics were similar in both groups with higher EuroSCORE II in group B (3.1 vs. 2.7%, p = 0.04). Early postoperative outcome showed comparable results between groups A and B, with higher re-thoracotomy rate in group B patients (0.0 vs. 22.1%, p = 0.002). Overall mortality was 7.4% during the observational period with a maximum of 85 months. SF-36 observation showed a significant decay in both physical component summary (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). There was no significant difference between group A and B. Compared with MI and CAD patients, significantly higher PCS and MCS scores were detected in this study population (p < 0.05).

Conclusion: Replacement of the AA shows low risk regarding operative and postoperative outcome with very satisfying long-term results in QoL. QoL is similar to the NP an even better than MI or CAD patients. The extent of the surgical procedure does not influence the postoperative QoL.

Publication History

Article published online:
28 January 2023