Long-Term Outcomes in Major Aortic Surgery: 11 Year Single Centre Experience

Long-Term Outcomes in Major Aortic Surgery: 11 Year Single Centre Experience | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Long-Term Outcomes in Major Aortic Surgery: 11 Year Single Centre Experience Edward Staniforth, Iakovos Ttofi, Jasmina Ttofi, Vanitha Perinparajah, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4572458/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 20 Dec, 2024 Read the published version in Journal of Cardiothoracic Surgery → Version 1 posted 16 You are reading this latest preprint version Abstract Objectives Thoracic aortic aneurysms and dissections provide a complex surgical cohort termed major aortic surgery. Regular follow-up at specialist clinics with cross-sectional imaging is recommended. Identifying risk factors that lead to re-operations as well as the requirement for and appropriate length of follow-up remain points of debate. Methods Patients undergoing any major aortic operation performed at a single centre from January 2012 to December 2022 were retrospectively reviewed. The clinical information, operative details, histological reports, post-operative outcomes and follow up were collected from electronic patient records. Statistical analysis was performed using Microsoft Excel and R Studio. Results 409 patients met the inclusion criteria for the study with a median follow-up of 3.8 years (IQR 1.6–7.6). The prevalence of all cause re-operations was 10.8% (n = 44). The median time to re-operation was 1.8 years. 68% of the reoperations occurred within the first 5 years. Multi and univariate logistic regression identified young age, arteritis and/or aortitis as the main risk factors associated with increased risk of re-operation. Connective tissue disease and systemic inflammatory diseases approached but didn’t meet statistical significance. Bicuspid aortic valve pathology was associated with reduced risk of re-operation. Conclusions Patients undergoing major-aortic surgery have a high rate of re-operation. The first 5 years represent a high-risk period and follow-up with cross-sectional imaging during that time by specialist aortic services is essential. Patient with aortitis remain at high risk and should be treated by appropriate by specialist aortic services with subspecialty interest and expertise on treating patients with aortitis. Cardiac surgery aorta aortic aneurysm type A aortic dissection follow-up Figures Figure 1 Introduction/Background Thoracic aortic aneurysms and type A aortic dissections (TAAD) provide a complex surgical cohort which is often termed major aortic surgery. Major aortic surgery can be limited to isolated segments, such as an interpositional graft in the ascending aorta, to near total replacement of the thoracic aorta with a frozen elephant trunk. The extent of aortic replacement depends on the extent of the pathology, which can be performed in an elective setting for aneurysms and in the emergency setting for TAAD. The incidence of major aortic surgery is increasing globally as healthcare screening and investigations detect more aortic aneurysms and dissections 1 . Despite improvements in outcomes, the risks are still relatively high and major aortic surgery continues to be associated with significant morbidity and mortality 2 – 5 . National reports from the United Kingdom (UK) have reported reduced in-hospital mortality for operations on the ascending aorta from 11.6% in 2002/3 to 8.9% in 2015/16 with little change in patient age 6 and emergency thoracic aortic surgery (mainly type A dissections) from 20.2% in 2013-14 to 17.2% in 2021 − 22 7 . Reporting outcomes in major aortic surgery is challenging due to the range of procedures performed on the aorta in cardiac surgery. Despite this, cardiac surgeons in the UK have led the way in transparency in the National Health Service (NHS) by creating a national database and publishing the outcomes of cardiac surgery. The Society for Cardiac Surgery reports regularly on the outcomes of cardiac surgery 6 . Furthermore, cardiac surgery in the UK is independently reviewed by the National Adult Cardiac Surgery Audit which analyses both unit and surgeon specific outcomes in cardiac surgery 8 . Whilst this drives surgical excellence through reporting short term in-hospital outcomes, long term outcomes are not included. In the UK, cardiac surgery is centralised in tertiary centres to create high volume units 9 . The subspecialisation of aortic surgery has been demonstrated to improve outcomes, with data from Liverpool reporting that when aortic specialists operated on TAAD, the observed mortality can be reduced by 50% 10 . Whilst high volume units optimise surgical excellence, follow-up in the UK is often scattered between cardiothoracic centres and local cardiology units. This, in combination with the lack of requirement for national auditing for long term outcomes, has resulted in there being limited long term data on the outcomes in major aortic surgery and little consensus on who and how long these patients should typically be followed up for. It is important therefore to systematically record complications and problems in the follow-up of patients. We performed a single centre, retrospective, cross sectional study over an 11-year period of patients who underwent major aortic surgery. The primary outcome was to investigate the temporal nature of re-operations and risk factors associated with re-operations to provide evidence for an appropriate length of follow-up. Methods Ethical Statement This study was carried out in accordance with the Declaration of Helsinki. All patients included in this study provided written informed consented to the use of their data in clinical audits and research. Human ethics was not required. This study was approved by Oxford University Hospitals NHS Foundation Trust (Audit Number: 8036) Data Collection and Sorting This is a retrospective cohort study. We reviewed all logged major aortic operations in the cardiothoracic department performed at Oxford University Hospitals NHS Foundation Trust, United Kingdom, between 1/1/2012 and 31/12/2022. Major aortic operations were defined as all operations performed on TAAD and surgical repairs of aneurysms in the root, ascending and/or arch of the aorta. The inclusion criterion for this study was major aortic operations due to a non-infectious aetiology with complete histological reports and cardiovascular risk factors to allow regression analysis. We chose not to filter our dataset to remove certain types of major aortic surgery, such as those involving the aortic arch, as we wanted to provide real world data on the outcomes of aortic surgery within an aortic unit. The primary aim was to investigate the long-term risk of re-operations. Our secondary aim was to use logistic regression to investigate risk factors for re-operation. Regression analysis was also performed on re-operations only due to new aneurysms, dissection, deep graft infections and pseudoaneurysms. This was chosen as cross sectional imaging would be required to monitor these changes. All cardiothoracic operations at the hospital are stored on a database. Data on major aortic operations performed between 1/1/2012 and 31/12/2022 were extracted for patients who had consented the use of their information for audit and research. In addition to patient names, the database also contained their age at surgery, date of operation and cardiovascular risk factors. Over the period from January to March 2023, medical notes were reviewed using the local electronic patient record system. The following information was collected: intra-operative details, the major indication for surgery, past medical history, aortic valve type, presence or absence of infective endocarditis, histological report and post-operative outcomes including requirement for further surgery. Re-operations were defined as all patients who had a re-operation, patients who were listed for a re-operation but at the point of data collection had not yet received it, and patients who required one but were medically unfit. Re-operations in the immediate post-operative period, such as due to post-operative bleeding and surgical site infections were excluded from the analysis. Arteritis was defined as a previous rheumatological diagnosis of arteritis in another vascular bed which included Giant Cell Arteritis, Takayasu’s arteritis and ANCA positive vasculitis 11 . Aortitis was defined when the histology sample taken at the time of the operation reported aortitis 12 . Other inflammatory conditions included inflammatory and autoimmune diseases which are associated with an increased risk of cardiovascular events such as Crohn’s disease, polymyalgia rheumatica, systemic lupus erythematous and rheumatoid arthritis 13 . Connective tissue diseases included Marfan’s Syndrome, Loez-Dietz Syndrome and hereditary thoracic aortic disease. Patients were classified as diabetic if they were on oral hypoglycaemic medication and/or insulin. Hypertension was classified as: when patients were already under treatment for hypertension or if the blood pressure was recorded as > 140mmHg/90mmHg on more than one occasion prior to surgery. Smoking status was grouped as current, previous, or never smoker. Seven patients underwent major aortic surgery prior to 2012 but received further surgery within the time frame we investigated. This cohort was included as they provide valuable information on long term outcomes in major aortic surgery. Their age and date of operation was corrected for their first operation. If only the year of the previous surgery was only available, then it was recorded as the first of June of the year given. Statistical Analysis Statistical analysis was performed on Microsoft Excel and R using RStudio (Version 2022.07.2). Variables were checked for normality. Descriptive statistics were employed to summarised patient demographics and indications for re-operations. Logistic regression was used to investigate risk factors for all cause re-operations and specifically for aneurysms, dissection graft infections and pseudoaneurysms. Prior to running logistic regression, predictors were included if they were present in more than 2.5% of the patients to ensure the features truly explain the dataset. Variables were grouped as necessary. Residual diagnostic regression testing was conducted for the primary outcomes. Linearity of continuous variables with the outcomes was assessed using fractional polynomials and collinearity between variable was assessed by the variance inflation factor (VIF). Results Patient Demographics Between 2012 and 2022, 690 procedures logged as major aortic operations were performed on 678 patients on the hospital database. On review of the medical records, 612 patients were confirmed to have undergone major aortic surgery (423 aneurysms, 189 TAADs). 8 patients were excluded due to infective endocarditis, 72 due to a lack of aortic histology report and 123 were removed due to incomplete dataset of cardiovascular risk factors. The remaining 409 patients all met the inclusion criteria of our study. The median follow-up time was 3.8 years (IQR 1.6–7.6) and the longest follow-up was 29.6 years. The major indication for initial surgery was aortic aneurysms (71%) and the median age at operation was 63 with a negative skew. At the point of data collection, 88.9% ( n = 363) of patients were alive. The demographics of the patients included are summarised in Table 1. Patients undergoing major aortic surgery were more likely to be male (67%). The dataset included patients with connective tissue disease such as Marfan’s syndrome and Loez-Dietz syndrome, as well as patients with arteritis, aortitis and systemic inflammatory conditions which are associated with aortic aneurysms and dissections 14 . Survival Patients undergoing major aortic surgery were at high risk of mortality of up to 18.2% at 8 years post-surgery (Table 2). Most deaths occurred within the first year (1 year adjusted mortality = 8.1%, n = 29/358). As expected, mortality is much higher in aortic dissections in comparison to aneurysms. Re-Operations Patients undergoing major aortic surgery are at a relatively high risk of reoperation (10.8% (n = 44/409). Aortic dissections had a higher rate of reoperations at 14.2% in comparison to surgery for aneurysms (9.3%), but this did not achieve statistical significance (Pearson’s Chi-squared test, P = 0.2). The cause of re-operation varied from aortic valve failure to the development of new aneurysms and dissection flap extensions which were managed with open and/or endovascular surgery (Table 3). The median time to re-operation was 1.8 years (IQR 1.0-4.4) with 68% (n = 30/44) occurring within the first 5 years. Early causes of reoperation outside of the post-operative period were typically graft infections and aneurysms. As time from the initial operation increased, the development and new aneurysms and valve failure became the predominant indication for re-operation (Fig. 1). Risk Factors for Re-Operations Univariate and multivariate logistic regression was performed to investigate the risk factors for all cause re-operations (Table 4). Univariate regression identified arteritis and/or aortitis as significantly associated with increased risk of re-operation, whilst increased age and bicuspid aortic valve were associated with a statistically significant reduction in the rate of re-operation. Connective tissue disease and current smoking approached but did not achieve statistical significance for re-operation. Multivariate regression also identified arteritis and/or aortitis as significantly associated with increased risk of re-operation, whilst increased age and bicuspid aortic valve were associated with a statistically significant reduction. The effect of connective tissue disease was not seen in multivariate regression, likely due to its association with younger age. Logistic regression analysis was also performed looking at risk factors for re-operations specifically due to new aneurysms, dissection, graft infections and pseudoaneurysms as these would require cross sectional imaging to diagnose (Table 5). Multivariate logistic regression revealed that inflammatory diseases significantly increase the risk of re-operation and bicuspid aortic valve is associated with a significant reduction in the risk of re-operation. Discussion Outcomes in Major Aortic Surgery Major aortic operations provide a complicated surgical cohort, and associated mortality remains high with overall 5-year mortality at 14.3% (lower for aneurysms - higher for TAAD) (Table 2). Our 28-day mortality, which we have used as a metric to compare to in-hospital survival to national datasets is much lower than the 8.9% quoted for operations of the ascending aorta in the UK 6 . Our reported mortality rates are comparable to some other studies who also reported 93% 5-year survival for elective aortic root replacement 15 , 74% 10-year survival for hemi-arch surgery 16 and 20–40% 10-year mortality for TAAD 17 , 18 . The re-operation rate in out cohort was 10.4% (9.3% for aneurysms and 14.2% for dissections), which is concordant with other reports in the literature 2 . The first 5 years represents a particularly high-risk period. Whilst our dataset was theoretically limited by having a median follow-up of 3.8 years, we included patients who had a major aortic surgery outside of a period we investigated who required a re-intervention within the time frame. The relatively small number of patients who were in the group therefore suggests that the first 5 years is likely correct, but longer follow-up would be required to confirm this. Due to the relatively small size of this cohort, multi-centre collaboration would be important to quantify this risk. We identified younger age and arteritis and/or aortitis as statistically associated with an increased risk of re-operations, with current smoking and connective tissue disease approaching but not achieving statistical significance (Table 4). Interestingly, bicuspid aortic valve in our cohort represented a decreased risk for re-operation. Requirement for a new follow-up pathway The relatively high re-operation rate likely necessitates additional follow-up of specific patients within the cohort. Whilst the causes of re-operation are varied, it is important to ensure patients are monitored for complications that develop silently as these can progress to a catastrophic event such as new aneurysms, dissections, graft infections and pseudoaneurysms. A recent audit in our department identified that most patients in this cohort are followed-up for one year before being discharged to local cardiology services. At our unit we have now setup a complex aortic clinic as part of a local initiative to provide a standardised specialist follow-up for all aortic cases who had a surgical intervention or diagnosed have been diagnosed with an aortic aneurysm and are currently under surveillance. This includes patients with aortitis and other high-risk groups which are reviewed annually with cross sectional imaging. Cardiac surgery works closely with cardiology who also provide specialist genetic counselling to the appropriate cohort of patients and rheumatology department for patients with aortitis. It is however important to realise that the surgical complications of major aortic surgery likely fall outside of the remits of cardiology and rheumatology. Vascular surgery and interventional radiology are also closely aligned in providing comprehensive and holistic treatment options through multidisciplinary team meetings and integrated services within out hospital. Additionally, input from geriatric services, aortic specialist anaesthetic colleagues and intensivists are often vital to the decision-making process. We believe this multi-disciplinary approach (which has been rapidly adopted by many aortic centres worldwide) is the best way of managing patients with complex aortic disease. It offers the right environment for clinicians to explore and implement the most appropriate therapies, individualised to patient’s needs, genetic profile, urgency, and other patient specific clinical and social circumstances. Limitations This is a retrospective cohort study. Due to the limitations associated with retrospective studies, subthreshold events, such as a new small aneurysm, can be hard to detect when regular cross-sectional imaging is not performed in a regimented fashion. However, it is possible to monitor the requirement for a re-intervention and long-term survival with retrospective data. Cardiovascular risk factor reporting and histological sampling of the aorta was absent in some patients, which resulted in them being excluded from the analysis. Conclusions Patients undergoing major aortic surgery are at a high risk for re-intervention. The first 5 years represent a highest risk-period for reintervention and follow-up during that time by specialist aortic services is essential. We recommend annual review with cross sectional imaging during this period, and possibility decreasing frequency afterwards. Longer term follow-up will be required to validate the exact frequency of follow-up beyond 5 years. Abbreviations TAAD Type A Aortic Dissection NHS National Health Service UK United Kingdom Declarations Funding Statement: No funding was sought Conflict of Interest Statement: SD has received advisory fees from Boehringer Ingelheim GmbH and Bristol Myers Squibb and speaker fees from Janssen. GK has received advisory fees, consultancy fees and financial educational support from: Atricure, Terumo-Vascutec, Medistim, Abbott, Medronic, Ethicon - Johnson & Johnson, Artivion, Zimmer & Nuffield Health. He is also the director of Cardiac Surgery GK Ltd. RU has received an educational grant from Terumo Aortic E Sideso has received consultancy fees and educational grants from Terumo Aortic Contribution Statement: Edward Staniforth : Conceptualisation, project administration, methodology, investigation, formal analysis, validation, writing-original draft, writing- review and editing. Iakovos Ttfofi : Conceptualisation, methodology, investigation, writing- review and editing. Jasmina Ttofi : Conceptualisation, methodology, investigation, writing- review and editing. Vanitha Perinparajah: formal analysis, writing – review and editing, Rohit Vijjhalwar : Methodology, formal analysis, validation, writing– review and editing. Raman Uberoi : writing– review and editing. Ediri Sideso: writing– review and editing. Shirish Dubey : Validation, Supervision, Writing – review and editing. George Krasopoulos : Conceptualisation, project administration, methodology, supervision, writing- review and editing. Data Availability Statement: Data is available on request. Human Ethics and Consent to Participate Declaration: This study was carried out in accordance with the Declaration of Helsinki. All patients included in this study provided written informed consented to the use of their data in clinical audits and research. Human ethics was not required. This study was approved by Oxford University Hospitals NHS Foundation Trust (Audit Number: 8036) References Wang Z, You Y, Yin Z, et al. Burden of Aortic Aneurysm and Its Attributable Risk Factors from 1990 to 2019: An Analysis of the Global Burden of Disease Study 2019. Frontiers in cardiovascular medicine . 2022;9:901225. Gariboldi V, Grisoli D, Kerbaul F, et al. Long-term outcomes after repaired acute type A aortic dissections. Interact Cardiovasc Thorac Surg . 2007;6:47-51. Harris KM, Nienaber CA, Peterson MD, et al. Early Mortality in Type A Acute Aortic Dissection: Insights From the International Registry of Acute Aortic Dissection. JAMA Cardiol . 2022;7:1009-1015. Di Eusanio M, Berretta P, Cefarelli M, et al. Long-term outcomes after aortic arch surgery: results of a study involving 623 patients. Eur J Cardiothorac Surg . 2015;48:483-490. Hernandez-Vaquero D, Silva J, Escalera A, et al. Life Expectancy after Surgery for Ascending Aortic Aneurysm. J Clin Med . 2020;9:615. The Society for Cardiothoracic Surgery in Great Britain and Ireland National Cardiac Surgery Activity and Outcomes Report 2002–2016 . Available at: https://scts.org/_userfiles/pages/files/sctscardiacbluebook2020_11_20tnv2.pdf. Accessed 20th May, 2024. NACSA Annual Report 2023 (Data for the 3 years - from April 2019 to March 2022) Appendix – additional data (including all data from which main report derived) . Available at: https://www.nicor.org.uk/national-cardiac-audit-programme/previous-reports/adult-cardiac-surgery-1/2023/appendix-of-data-for-2023?layout=default. Accessed 20th May, 2024. NACSA 2024 Summary Report. Available at: https://www.nicor.org.uk/publications/ncap/cardiac-surgery-audit/2024-6/nacsa-final-report-2022-23/?layout=default. Accessed 20th May, 2024. Richens David. GIRFT Cardiothoracic Surgery Report 2018. Available at: https://gettingitrightfirsttime.co.uk/wp-content/uploads/2018/04/GIRFT-Cardiothoracic-Report-1.pdf. Accessed March 11, 2024. Bashir M, Shaw M, Field M, et al. Repair of type A dissection-benefits of dissection rota. Annals of cardiothoracic surgery . 2016;5:209-215. Pugh D, Grayson P, Basu N, Dhaun N. Aortitis: recent advances, current concepts and future possibilities. Heart . 2021;107:1620-1629. Stone JR, Bruneval P, Angelini A, et al. Consensus statement on surgical pathology of the aorta from the Society for Cardiovascular Pathology and the Association for European Cardiovascular Pathology: I. Inflammatory diseases. Cardiovascular pathology . 2015;24:267-278. Sorriento D, Iaccarino G. Inflammation and Cardiovascular Diseases: The Most Recent Findings. Int J Mol Sci . 2019;20:3879. Bossone E, Eagle KA. Epidemiology and management of aortic disease: aortic aneurysms and acute aortic syndromes. Nat Rev Cardiol . 2021;18:331-348. Jahangiri M, Mani K, Acharya M, et al. Early and long-term outcomes of conventional and valve-sparing aortic root replacement. Heart . 2022;108:1858-1863. Pearsall C, Blitzer D, Zhao Y, et al. Long-term outcome of hemiarch replacement in a proximal aortic aneurysm repair: analysis of over 1000 patients. European journal of cardio-thoracic surgery . 2022;62. Gariboldi V, Grisoli D, Kerbaul F, et al. Long-term outcomes after repaired acute type A aortic dissections. Interactive cardiovascular and thoracic surgery . 2007;6:47-51. Jormalainen M, Kesävuori R, Raivio P, et al. Long-term outcomes after ascending aortic replacement and aortic root replacement for type A aortic dissection. Interact Cardiovasc Thorac Surg . 2022;34:453-461. Tables Table 1 Demographics of patient undergoing major aortic surgery. Patient Demographics N = 409 Age 63 (52, 72) 1 Sex (Male) 277 (68%) BMI 26.8 (23.9, 30.9) 1 Hypercholesterolemia 136 (33%) Diabetes 17 (4.2%) Hypertension 277 (68%) Smoking Status Current Smoker 40 (9.8%) Previous Smoker 132 (32%) Never Smoker 237 (58%) Previous Cardiac Surgery 26 (6.4%) Bicuspid Aortic Valve 153 (37%) Previous Type B Dissection 8 (2.0%) Connective Tissue Disease 27 (6.6%) Arteritis 10 (2.4%) Aortitis 46 (11%) Systemic Inflammatory Condition 15 (3.7%) Previous Chemotherapy or Radiotherapy 4 (1.0%) 1 Median (IQR); n (%) Table 2 Mortality adjusted for length of follow-up and indication for operation. Follow-Up Time All-Group Mortality Aneurysm Mortality TAAD Mortality 28 Day Mortality 3.9% (n = 16/409) 2.1% (n = 6/289) 8.3% (n = 10/120) 1 Year Mortality 8.1% (n = 29/358) 4.8% (n = 12/250) 15.7% (n = 17/108) 2 Year Mortality 9.7% (n = 30/308) 6.5% (n = 14/214) 17.0% (n = 16/94) 3 Year Mortality 10.1% (n = 26/258) 6.1% (n = 11/179) 19.0% (n = 15/79) 4 Year Mortality 11.7% (n = 24/206) 5.6% (n = 8/143) 25.4% (n = 16/63) 5 Year Mortality 14.3% (n = 22/154) 5.5% (n = 6/110) 36.4% (n = 16/44) 6 Year Mortality 15.0% (n = 16/107) 6.4% (n = 5/78) 37.9% (n = 11/29) 7 Year Mortality 17.3% (n = 14/81) 8.8% (n = 5/57) 37.5% (n = 9/24) 8 Year Mortality 18.2% (n = 12/66) 8.3% (n = 4/48) 44.4% (n = 8/18) TAAD = Type A Aortic Dissection Table 3 Indications for re-operations, separated by indication for initial operation. Indication for Re-Operation All-Group N = 44 Aneurysm n = 27 1 TAAD n = 17 1 Aortic Valve Failure (Native or Replacement) 6 (14%) 6 (22%) 0 (0%) Graft Infection 11 (25%) 8 (30%) 3 (18%) Pseudoaneurysm 3 (6.8%) 1 (3.7%) 2 (12%) Aneurysm 21 (48%) 12 (44%) 9 (53%) Dissection 3 (6.8%) 0 (0%) 3 (18%) 1 n (%), TAAD = Type A Aortic Dissection Table 4 Univariate and multivariate logistic regression for predicators of all cause re-operations from major aortic surgery. Univariate Multivariate Predictor OR 1 95% CI 1 p-value OR 1 95% CI 1 p-value Increased Age 0.97 0.96, 0.99 0.012* 0.96 0.93, 0.99 0.004** Male 0.73 0.39, 1.42 0.341 0.99 0.48, 2.10 > 0.9 BMI 0.97 0.90, 1.04 0.357 0.98 0.91, 1.05 0.6 Hypercholesterolemia 0.56 0.25, 1.13 0.121 0.75 0.31, 1.72 0.5 Hypertension 1.02 0.53, 2.06 0.945 1.64 0.72, 3.90 0.2 Current Smoker 2.31 0.93, 5.19 0.053 1.66 0.60, 4.21 0.3 Previous Smoker 0.77 0.37, 1.50 0.454 1.02 0.46, 2.18 > 0.9 Previous Cardiac Surgery 0.68 0.11, 2.39 0.604 0.99 0.15, 3.91 > 0.9 Bicuspid Aortic Valve 0.34 0.14, 0.71 0.007** 0.36 0.14, 0.86 0.027* Connective Tissue Disease 2.59 0.90, 6.47 0.054 0.96 0.26, 3.14 > 0.9 Arteritis and/or Aortitis 2.79 1.26, 5.82 0.008** 2.71 1.08, 6.54 0.029* Systemic Inflammatory Disease 3.22 0.86, 9.91 0.054 2.75 0.67, 9.59 0.13 1 OR = Odds Ratio, CI = Confidence Interval, * = P < 0.05, ** = P < 0.01 Table 5 Univariate and multivariate logistic regression for predicators of re-operations due to aneurysms, dissections, graft infections and pseudoaneurysms. Univariate Multivariate Predictor OR 1 95% CI 1 p-value OR 1 95% CI 1 p-value Increased Age 0.99 0.96, 1.01 0.192 0.97 0.94, 0.99 0.021* Male 0.80 0.40, 1.64 0.528 1.24 0.56, 2.86 0.6 BMI 0.99 0.92, 1.06 0.728 0.99 0.92, 1.07 0.9 Hypercholesterolemia 0.60 0.26, 1.25 0.193 0.69 0.27, 1.65 0.4 Hypertension 1.19 0.58, 2.57 0.645 1.43 0.60, 3.64 0.4 Current Smoker 2.83 1.13, 6.44 0.018* 1.87 0.66, 4.88 0.2 Previous Smoker 0.73 0.33, 1.50 0.411 1.02 0.43, 2.32 > 0.9 Previous Cardiac Surgery 0.80 0.13, 2.86 0.772 1.60 0.24, 6.57 0.6 Bicuspid Aortic Valve 0.23 0.08, 0.55 0.003** 0.20 0.06, 0.55 0.004** Connective Tissue Disease 1.24 0.28, 3.78 0.736 0.45 0.09, 1.79 0.3 Arteritis and/or Aortitis 3.47 1.55, 7.39 0.002** 3.23 1.25, 8.04 0.013* Systemic Inflammatory Disease 3.85 1.02, 11.96 0.027* 2.85 0.68, 10.1 0.12 1 OR = Odds Ratio, CI = Confidence Interval, * = P < 0.05, ** = P < 0.01 Additional Declarations Competing interest reported. SD has received advisory fees from Boehringer Ingelheim GmbH and Bristol Myers Squibb and speaker fees from Janssen. GK has received advisory fees, consultancy fees and financial educational support from: Atricure, Terumo-Vascutec, Medistim, Abbott, Medronic, Ethicon - Johnson & Johnson, Artivion, Zimmer & Nuffield Health. He is also the director of Cardiac Surgery GK Ltd. RU has received an educational grant from Terumo Aortic E Sideso has received consultancy fees and educational grants from Terumo Aortic Supplementary Files floatimage1.jpeg Graphical Abstract Cite Share Download PDF Status: Published Journal Publication published 20 Dec, 2024 Read the published version in Journal of Cardiothoracic Surgery → Version 1 posted Editorial decision: Revision requested 29 Jul, 2024 Reviews received at journal 16 Jul, 2024 Reviews received at journal 11 Jul, 2024 Reviews received at journal 11 Jul, 2024 Reviewers agreed at journal 06 Jul, 2024 Reviewers agreed at journal 06 Jul, 2024 Reviews received at journal 05 Jul, 2024 Reviewers agreed at journal 04 Jul, 2024 Reviews received at journal 02 Jul, 2024 Reviewers agreed at journal 02 Jul, 2024 Reviewers agreed at journal 02 Jul, 2024 Reviewers agreed at journal 01 Jul, 2024 Reviewers invited by journal 01 Jul, 2024 Editor assigned by journal 17 Jun, 2024 Submission checks completed at journal 17 Jun, 2024 First submitted to journal 12 Jun, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4572458","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":321589459,"identity":"c65b5e0d-7dd7-4d23-a0f3-f38962b35ca4","order_by":0,"name":"Edward Staniforth","email":"","orcid":"","institution":"Oxford University Medical School, University of Oxford","correspondingAuthor":false,"prefix":"","firstName":"Edward","middleName":"","lastName":"Staniforth","suffix":""},{"id":321589462,"identity":"cbc1bc18-cb59-46fd-8ad3-d2e601ea4c56","order_by":1,"name":"Iakovos Ttofi","email":"","orcid":"","institution":"Department of Cardiac Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust","correspondingAuthor":false,"prefix":"","firstName":"Iakovos","middleName":"","lastName":"Ttofi","suffix":""},{"id":321589464,"identity":"37fd2c09-1635-422e-9c53-af34405cf984","order_by":2,"name":"Jasmina Ttofi","email":"","orcid":"","institution":"Department of Cardiac Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust","correspondingAuthor":false,"prefix":"","firstName":"Jasmina","middleName":"","lastName":"Ttofi","suffix":""},{"id":321589465,"identity":"0cd09bf0-bf4b-4351-9f40-b2ab4acf1b41","order_by":3,"name":"Vanitha Perinparajah","email":"","orcid":"","institution":"Department of Cardiac Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust","correspondingAuthor":false,"prefix":"","firstName":"Vanitha","middleName":"","lastName":"Perinparajah","suffix":""},{"id":321589466,"identity":"28a5b14b-41aa-405b-a78b-00e7284d9ccb","order_by":4,"name":"Rohit Vijjhalwar","email":"","orcid":"","institution":"Oxford University Medical School, University of Oxford","correspondingAuthor":false,"prefix":"","firstName":"Rohit","middleName":"","lastName":"Vijjhalwar","suffix":""},{"id":321589467,"identity":"03638a17-ff3c-46b6-b789-50719387a364","order_by":5,"name":"Raman Uberoi","email":"","orcid":"","institution":"Department of Rheumatology, Oxford University Hospitals NHS Foundation Trust","correspondingAuthor":false,"prefix":"","firstName":"Raman","middleName":"","lastName":"Uberoi","suffix":""},{"id":321589468,"identity":"9205c30f-567c-4b63-a4bd-905480d81b7d","order_by":6,"name":"Ediri Sideso","email":"","orcid":"","institution":"Department of Vascular Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust","correspondingAuthor":false,"prefix":"","firstName":"Ediri","middleName":"","lastName":"Sideso","suffix":""},{"id":321589469,"identity":"7a903d8d-f7ca-488d-90d4-ed244476389f","order_by":7,"name":"Shirish Dubey","email":"","orcid":"","institution":"Department of Rheumatology, Oxford University Hospitals NHS Foundation Trust","correspondingAuthor":false,"prefix":"","firstName":"Shirish","middleName":"","lastName":"Dubey","suffix":""},{"id":321589470,"identity":"4cacfc89-ddc9-4ed9-921c-f8de5a951594","order_by":8,"name":"George Krasopoulos","email":"data:image/png;base64,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","orcid":"","institution":"Department of Cardiac Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust","correspondingAuthor":true,"prefix":"","firstName":"George","middleName":"","lastName":"Krasopoulos","suffix":""}],"badges":[],"createdAt":"2024-06-12 21:09:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4572458/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4572458/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s13019-024-03153-4","type":"published","date":"2024-12-20T15:58:19+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":60353515,"identity":"f134549b-3ac8-40bc-b75a-373a34f5b247","added_by":"auto","created_at":"2024-07-15 23:41:34","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":106956,"visible":true,"origin":"","legend":"\u003cp\u003eGraph of re-operations by time (years) and indication.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4572458/v1/c8d229fb8edc41086553479f.png"},{"id":72202610,"identity":"7561c4bb-d706-47ab-b627-9e86c8cfcedc","added_by":"auto","created_at":"2024-12-23 16:15:04","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":702794,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4572458/v1/2b648c49-2453-4eec-837e-b65112b4f38f.pdf"},{"id":60353516,"identity":"735ba523-3217-44f5-901b-6433a9f55825","added_by":"auto","created_at":"2024-07-15 23:41:34","extension":"jpeg","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":468707,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eGraphical Abstract\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4572458/v1/6fc4bc3e2e8828a53a58b6bb.jpeg"}],"financialInterests":"Competing interest reported. SD has received advisory fees from Boehringer Ingelheim GmbH and Bristol Myers Squibb and speaker fees from Janssen.\n\nGK has received advisory fees, consultancy fees and financial educational support from: Atricure, Terumo-Vascutec, Medistim, Abbott, Medronic, Ethicon - Johnson \u0026 Johnson, Artivion, Zimmer \u0026 Nuffield Health. He is also the director of Cardiac Surgery GK Ltd.\n\nRU has received an educational grant from Terumo Aortic\n\nE Sideso has received consultancy fees and educational grants from Terumo Aortic","formattedTitle":"Long-Term Outcomes in Major Aortic Surgery: 11 Year Single Centre Experience","fulltext":[{"header":"Introduction/Background","content":"\u003cp\u003eThoracic aortic aneurysms and type A aortic dissections (TAAD) provide a complex surgical cohort which is often termed major aortic surgery. Major aortic surgery can be limited to isolated segments, such as an interpositional graft in the ascending aorta, to near total replacement of the thoracic aorta with a frozen elephant trunk. The extent of aortic replacement depends on the extent of the pathology, which can be performed in an elective setting for aneurysms and in the emergency setting for TAAD. The incidence of major aortic surgery is increasing globally as healthcare screening and investigations detect more aortic aneurysms and dissections\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. Despite improvements in outcomes, the risks are still relatively high and major aortic surgery continues to be associated with significant morbidity and mortality\u003csup\u003e\u003cspan additionalcitationids=\"CR3 CR4\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. National reports from the United Kingdom (UK) have reported reduced in-hospital mortality for operations on the ascending aorta from 11.6% in 2002/3 to 8.9% in 2015/16 with little change in patient age\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e and emergency thoracic aortic surgery (mainly type A dissections) from 20.2% in 2013-14 to 17.2% in 2021\u0026thinsp;\u0026minus;\u0026thinsp;22\u003csup\u003e7\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eReporting outcomes in major aortic surgery is challenging due to the range of procedures performed on the aorta in cardiac surgery. Despite this, cardiac surgeons in the UK have led the way in transparency in the National Health Service (NHS) by creating a national database and publishing the outcomes of cardiac surgery. The Society for Cardiac Surgery reports regularly on the outcomes of cardiac surgery\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. Furthermore, cardiac surgery in the UK is independently reviewed by the National Adult Cardiac Surgery Audit which analyses both unit and surgeon specific outcomes in cardiac surgery\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. Whilst this drives surgical excellence through reporting short term in-hospital outcomes, long term outcomes are \u003cb\u003enot\u003c/b\u003e included.\u003c/p\u003e \u003cp\u003eIn the UK, cardiac surgery is centralised in tertiary centres to create high volume units\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e. The subspecialisation of aortic surgery has been demonstrated to improve outcomes, with data from Liverpool reporting that when aortic specialists operated on TAAD, the observed mortality can be reduced by 50%\u003csup\u003e10\u003c/sup\u003e. Whilst high volume units optimise surgical excellence, follow-up in the UK is often scattered between cardiothoracic centres and local cardiology units. This, in combination with the lack of requirement for national auditing for long term outcomes, has resulted in there being limited long term data on the outcomes in major aortic surgery and little consensus on who and how long these patients should typically be followed up for.\u003c/p\u003e \u003cp\u003eIt is important therefore to systematically record complications and problems in the follow-up of patients. We performed a single centre, retrospective, cross sectional study over an 11-year period of patients who underwent major aortic surgery. The primary outcome was to investigate the temporal nature of re-operations and risk factors associated with re-operations to provide evidence for an appropriate length of follow-up.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eEthical Statement\u003c/span\u003e\u003c/p\u003e\u003cp\u003eThis study was carried out in accordance with the Declaration of Helsinki. All patients included in this study provided written informed consented to the use of their data in clinical audits and research. Human ethics was not required. This study was approved by Oxford University Hospitals NHS Foundation Trust (Audit Number: 8036)\u003c/p\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eData Collection and Sorting\u003c/span\u003e\u003c/p\u003e\u003cp\u003eThis is a retrospective cohort study. We reviewed all logged major aortic operations in the cardiothoracic department performed at Oxford University Hospitals NHS Foundation Trust, United Kingdom, between 1/1/2012 and 31/12/2022. Major aortic operations were defined as all operations performed on TAAD and surgical repairs of aneurysms in the root, ascending and/or arch of the aorta. The inclusion criterion for this study was major aortic operations due to a non-infectious aetiology with complete histological reports and cardiovascular risk factors to allow regression analysis. We chose not to filter our dataset to remove certain types of major aortic surgery, such as those involving the aortic arch, as we wanted to provide real world data on the outcomes of aortic surgery within an aortic unit. The primary aim was to investigate the long-term risk of re-operations. Our secondary aim was to use logistic regression to investigate risk factors for re-operation. Regression analysis was also performed on re-operations only due to new aneurysms, dissection, deep graft infections and pseudoaneurysms. This was chosen as cross sectional imaging would be required to monitor these changes.\u003c/p\u003e\u003cp\u003eAll cardiothoracic operations at the hospital are stored on a database. Data on major aortic operations performed between 1/1/2012 and 31/12/2022 were extracted for patients who had consented the use of their information for audit and research. In addition to patient names, the database also contained their age at surgery, date of operation and cardiovascular risk factors. Over the period from January to March 2023, medical notes were reviewed using the local electronic patient record system. The following information was collected: intra-operative details, the major indication for surgery, past medical history, aortic valve type, presence or absence of infective endocarditis, histological report and post-operative outcomes including requirement for further surgery.\u003c/p\u003e\u003cp\u003eRe-operations were defined as all patients who had a re-operation, patients who were listed for a re-operation but at the point of data collection had not yet received it, and patients who required one but were medically unfit. Re-operations in the immediate post-operative period, such as due to post-operative bleeding and surgical site infections were excluded from the analysis. Arteritis was defined as a previous rheumatological diagnosis of arteritis in another vascular bed which included Giant Cell Arteritis, Takayasu\u0026rsquo;s arteritis and ANCA positive vasculitis\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. Aortitis was defined when the histology sample taken at the time of the operation reported aortitis\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. Other inflammatory conditions included inflammatory and autoimmune diseases which are associated with an increased risk of cardiovascular events such as Crohn\u0026rsquo;s disease, polymyalgia rheumatica, systemic lupus erythematous and rheumatoid arthritis\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. Connective tissue diseases included Marfan\u0026rsquo;s Syndrome, Loez-Dietz Syndrome and hereditary thoracic aortic disease. Patients were classified as diabetic if they were on oral hypoglycaemic medication and/or insulin. Hypertension was classified as: when patients were already under treatment for hypertension or if the blood pressure was recorded as \u0026gt;\u0026thinsp;140mmHg/90mmHg on more than one occasion prior to surgery. Smoking status was grouped as current, previous, or never smoker.\u003c/p\u003e\u003cp\u003eSeven patients underwent major aortic surgery prior to 2012 but received further surgery within the time frame we investigated. This cohort was included as they provide valuable information on long term outcomes in major aortic surgery. Their age and date of operation was corrected for their first operation. If only the year of the previous surgery was only available, then it was recorded as the first of June of the year given.\u003c/p\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eStatistical Analysis\u003c/span\u003e\u003c/p\u003e\u003cp\u003eStatistical analysis was performed on Microsoft Excel and R using RStudio (Version 2022.07.2).\u003c/p\u003e\u003cp\u003eVariables were checked for normality. Descriptive statistics were employed to summarised patient demographics and indications for re-operations.\u003c/p\u003e\u003cp\u003eLogistic regression was used to investigate risk factors for all cause re-operations and specifically for aneurysms, dissection graft infections and pseudoaneurysms. Prior to running logistic regression, predictors were included if they were present in more than 2.5% of the patients to ensure the features truly explain the dataset. Variables were grouped as necessary. Residual diagnostic regression testing was conducted for the primary outcomes. Linearity of continuous variables with the outcomes was assessed using fractional polynomials and collinearity between variable was assessed by the variance inflation factor (VIF).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ePatient Demographics\u003c/span\u003e\u003c/p\u003e\u003cp\u003eBetween 2012 and 2022, 690 procedures logged as major aortic operations were performed on 678 patients on the hospital database. On review of the medical records, 612 patients were confirmed to have undergone major aortic surgery (423 aneurysms, 189 TAADs). 8 patients were excluded due to infective endocarditis, 72 due to a lack of aortic histology report and 123 were removed due to incomplete dataset of cardiovascular risk factors.\u003c/p\u003e\u003cp\u003eThe remaining 409 patients all met the inclusion criteria of our study. The median follow-up time was 3.8 years (IQR 1.6\u0026ndash;7.6) and the longest follow-up was 29.6 years. The major indication for initial surgery was aortic aneurysms (71%) and the median age at operation was 63 with a negative skew. At the point of data collection, 88.9% (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;363) of patients were alive. The demographics of the patients included are summarised in Table\u0026nbsp;1. Patients undergoing major aortic surgery were more likely to be male (67%). The dataset included patients with connective tissue disease such as Marfan\u0026rsquo;s syndrome and Loez-Dietz syndrome, as well as patients with arteritis, aortitis and systemic inflammatory conditions which are associated with aortic aneurysms and dissections\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eSurvival\u003c/span\u003e\u003c/p\u003e\u003cp\u003ePatients undergoing major aortic surgery were at high risk of mortality of up to 18.2% at 8 years post-surgery (Table\u0026nbsp;2). Most deaths occurred within the first year (1 year adjusted mortality\u0026thinsp;=\u0026thinsp;8.1%, n\u0026thinsp;=\u0026thinsp;29/358). As expected, mortality is much higher in aortic dissections in comparison to aneurysms.\u003c/p\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eRe-Operations\u003c/span\u003e\u003c/p\u003e\u003cp\u003ePatients undergoing major aortic surgery are at a relatively high risk of reoperation (10.8% (n\u0026thinsp;=\u0026thinsp;44/409). Aortic dissections had a higher rate of reoperations at 14.2% in comparison to surgery for aneurysms (9.3%), but this did not achieve statistical significance (Pearson\u0026rsquo;s Chi-squared test, P\u0026thinsp;=\u0026thinsp;0.2). The cause of re-operation varied from aortic valve failure to the development of new aneurysms and dissection flap extensions which were managed with open and/or endovascular surgery (Table\u0026nbsp;3).\u003c/p\u003e\u003cp\u003eThe median time to re-operation was 1.8 years (IQR 1.0-4.4) with 68% (n\u0026thinsp;=\u0026thinsp;30/44) occurring within the first 5 years. Early causes of reoperation outside of the post-operative period were typically graft infections and aneurysms. As time from the initial operation increased, the development and new aneurysms and valve failure became the predominant indication for re-operation (Fig.\u0026nbsp;1).\u003c/p\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eRisk Factors for Re-Operations\u003c/span\u003e\u003c/p\u003e\u003cp\u003eUnivariate and multivariate logistic regression was performed to investigate the risk factors for all cause re-operations (Table\u0026nbsp;4). Univariate regression identified arteritis and/or aortitis as significantly associated with increased risk of re-operation, whilst increased age and bicuspid aortic valve were associated with a statistically significant reduction in the rate of re-operation. Connective tissue disease and current smoking approached but did not achieve statistical significance for re-operation. Multivariate regression also identified arteritis and/or aortitis as significantly associated with increased risk of re-operation, whilst increased age and bicuspid aortic valve were associated with a statistically significant reduction. The effect of connective tissue disease was not seen in multivariate regression, likely due to its association with younger age.\u003c/p\u003e\u003cp\u003eLogistic regression analysis was also performed looking at risk factors for re-operations specifically due to new aneurysms, dissection, graft infections and pseudoaneurysms as these would require cross sectional imaging to diagnose (Table\u0026nbsp;5). Multivariate logistic regression revealed that inflammatory diseases significantly increase the risk of re-operation and bicuspid aortic valve is associated with a significant reduction in the risk of re-operation.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eOutcomes in Major Aortic Surgery\u003c/span\u003e\u003c/p\u003e\u003cp\u003eMajor aortic operations provide a complicated surgical cohort, and associated mortality remains high with overall 5-year mortality at 14.3% (lower for aneurysms - higher for TAAD) (Table\u0026nbsp;2). Our 28-day mortality, which we have used as a metric to compare to in-hospital survival to national datasets is much lower than the 8.9% quoted for operations of the ascending aorta in the UK\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. Our reported mortality rates are comparable to some other studies who also reported 93% 5-year survival for elective aortic root replacement\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e, 74% 10-year survival for hemi-arch surgery\u003csup\u003e16\u003c/sup\u003e and 20\u0026ndash;40% 10-year mortality for TAAD\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThe re-operation rate in out cohort was 10.4% (9.3% for aneurysms and 14.2% for dissections), which is concordant with other reports in the literature\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. The first 5 years represents a particularly high-risk period. Whilst our dataset was theoretically limited by having a median follow-up of 3.8 years, we included patients who had a major aortic surgery outside of a period we investigated who required a re-intervention within the time frame. The relatively small number of patients who were in the group therefore suggests that the first 5 years is likely correct, but longer follow-up would be required to confirm this. Due to the relatively small size of this cohort, multi-centre collaboration would be important to quantify this risk.\u003c/p\u003e\u003cp\u003eWe identified younger age and arteritis and/or aortitis as statistically associated with an increased risk of re-operations, with current smoking and connective tissue disease approaching but not achieving statistical significance (Table\u0026nbsp;4). Interestingly, bicuspid aortic valve in our cohort represented a decreased risk for re-operation.\u003c/p\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eRequirement for a new follow-up pathway\u003c/span\u003e\u003c/p\u003e\u003cp\u003eThe relatively high re-operation rate likely necessitates additional follow-up of specific patients within the cohort. Whilst the causes of re-operation are varied, it is important to ensure patients are monitored for complications that develop silently as these can progress to a catastrophic event such as new aneurysms, dissections, graft infections and pseudoaneurysms. A recent audit in our department identified that most patients in this cohort are followed-up for one year before being discharged to local cardiology services. At our unit we have now setup a complex aortic clinic as part of a local initiative to provide a standardised specialist follow-up for all aortic cases who had a surgical intervention or diagnosed have been diagnosed with an aortic aneurysm and are currently under surveillance. This includes patients with aortitis and other high-risk groups which are reviewed annually with cross sectional imaging.\u003c/p\u003e\u003cp\u003eCardiac surgery works closely with cardiology who also provide specialist genetic counselling to the appropriate cohort of patients and rheumatology department for patients with aortitis. It is however important to realise that the surgical complications of major aortic surgery likely fall outside of the remits of cardiology and rheumatology. Vascular surgery and interventional radiology are also closely aligned in providing comprehensive and holistic treatment options through multidisciplinary team meetings and integrated services within out hospital. Additionally, input from geriatric services, aortic specialist anaesthetic colleagues and intensivists are often vital to the decision-making process. We believe this multi-disciplinary approach (which has been rapidly adopted by many aortic centres worldwide) is the best way of managing patients with complex aortic disease. It offers the right environment for clinicians to explore and implement the most appropriate therapies, individualised to patient\u0026rsquo;s needs, genetic profile, urgency, and other patient specific clinical and social circumstances.\u003c/p\u003e\u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eLimitations\u003c/span\u003e\u003c/p\u003e\u003cp\u003eThis is a retrospective cohort study. Due to the limitations associated with retrospective studies, subthreshold events, such as a new small aneurysm, can be hard to detect when regular cross-sectional imaging is not performed in a regimented fashion. However, it is possible to monitor the requirement for a re-intervention and long-term survival with retrospective data. Cardiovascular risk factor reporting and histological sampling of the aorta was absent in some patients, which resulted in them being excluded from the analysis.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003ePatients undergoing major aortic surgery are at a high risk for re-intervention. The first 5 years represent a highest risk-period for reintervention and follow-up during that time by specialist aortic services is essential. We recommend annual review with cross sectional imaging during this period, and possibility decreasing frequency afterwards. Longer term follow-up will be required to validate the exact frequency of follow-up beyond 5 years.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eTAAD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eType A Aortic Dissection\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNHS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNational Health Service\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eUK\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eUnited Kingdom\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding Statement:\u0026nbsp;\u003c/strong\u003eNo funding was sought\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest Statement:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSD has received advisory fees from\u0026nbsp;Boehringer Ingelheim GmbH and Bristol Myers Squibb and speaker fees from Janssen.\u003c/p\u003e\n\u003cp\u003eGK has received advisory fees, consultancy fees and financial educational support from: Atricure, Terumo-Vascutec, Medistim, Abbott, Medronic, Ethicon - Johnson \u0026amp; Johnson, Artivion, Zimmer \u0026amp; Nuffield Health. He is also the director of Cardiac Surgery GK Ltd.\u003c/p\u003e\n\u003cp\u003eRU has received an educational grant from Terumo Aortic\u003c/p\u003e\n\u003cp\u003eE Sideso has received consultancy fees and educational grants from Terumo Aortic\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eContribution Statement:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEdward Staniforth\u003c/strong\u003e: Conceptualisation, project administration, methodology, investigation, formal analysis, validation, writing-original draft, writing- review and editing. \u003cstrong\u003eIakovos Ttfofi\u003c/strong\u003e: Conceptualisation, methodology, investigation, writing- review and editing. \u003cstrong\u003eJasmina Ttofi\u003c/strong\u003e: Conceptualisation, methodology, investigation, writing- review and editing. \u003cstrong\u003eVanitha Perinparajah:\u003c/strong\u003e formal analysis, writing \u0026ndash; review and editing, \u003cstrong\u003eRohit Vijjhalwar\u003c/strong\u003e: Methodology, formal analysis, validation, writing\u0026ndash; review and editing. \u003cstrong\u003eRaman Uberoi\u003c/strong\u003e: writing\u0026ndash; review and editing. \u003cstrong\u003eEdiri Sideso:\u003c/strong\u003e writing\u0026ndash; review and editing.\u003cstrong\u003e\u0026nbsp;Shirish\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eDubey\u003c/strong\u003e: Validation, Supervision, Writing \u0026ndash; review and editing. \u003cstrong\u003eGeorge Krasopoulos\u003c/strong\u003e: Conceptualisation, project administration, methodology, supervision, writing- review and editing.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement:\u003c/strong\u003e Data is available on request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHuman Ethics and Consent to Participate Declaration:\u0026nbsp;\u003c/strong\u003eThis study was carried out in accordance with the Declaration of Helsinki. All patients included in this study provided written informed consented to the use of their data in clinical audits and research. Human ethics was not required. This study was approved by Oxford University Hospitals NHS Foundation Trust (Audit Number: 8036)\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWang Z, You Y, Yin Z, et al. Burden of Aortic Aneurysm and Its Attributable Risk Factors from 1990 to 2019: An Analysis of the Global Burden of Disease Study 2019. \u003cem\u003eFrontiers in cardiovascular medicine\u003c/em\u003e. 2022;9:901225.\u003c/li\u003e\n\u003cli\u003eGariboldi V, Grisoli D, Kerbaul F, et al. Long-term outcomes after repaired acute type A aortic dissections. \u003cem\u003eInteract Cardiovasc Thorac Surg\u003c/em\u003e. 2007;6:47-51.\u003c/li\u003e\n\u003cli\u003eHarris KM, Nienaber CA, Peterson MD, et al. Early Mortality in Type A Acute Aortic Dissection: Insights From the International Registry of Acute Aortic Dissection. \u003cem\u003eJAMA Cardiol\u003c/em\u003e. 2022;7:1009-1015.\u003c/li\u003e\n\u003cli\u003eDi Eusanio M, Berretta P, Cefarelli M, et al. Long-term outcomes after aortic arch surgery: results of a study involving 623 patients. \u003cem\u003eEur J Cardiothorac Surg\u003c/em\u003e. 2015;48:483-490.\u003c/li\u003e\n\u003cli\u003eHernandez-Vaquero D, Silva J, Escalera A, et al. Life Expectancy after Surgery for Ascending Aortic Aneurysm. \u003cem\u003eJ Clin Med\u003c/em\u003e. 2020;9:615.\u003c/li\u003e\n\u003cli\u003eThe Society for Cardiothoracic Surgery in Great Britain and Ireland National Cardiac Surgery Activity and Outcomes Report 2002\u0026ndash;2016 . Available at: https://scts.org/_userfiles/pages/files/sctscardiacbluebook2020_11_20tnv2.pdf. Accessed 20th May, 2024.\u003c/li\u003e\n\u003cli\u003eNACSA Annual Report 2023 (Data for the 3 years - from April 2019 to March 2022) Appendix \u0026ndash; additional data (including all data from which main report derived) . Available at: https://www.nicor.org.uk/national-cardiac-audit-programme/previous-reports/adult-cardiac-surgery-1/2023/appendix-of-data-for-2023?layout=default. Accessed 20th May, 2024.\u003c/li\u003e\n\u003cli\u003eNACSA 2024 Summary Report. Available at: https://www.nicor.org.uk/publications/ncap/cardiac-surgery-audit/2024-6/nacsa-final-report-2022-23/?layout=default. Accessed 20th May, 2024.\u003c/li\u003e\n\u003cli\u003eRichens David. GIRFT Cardiothoracic Surgery Report 2018. Available at: https://gettingitrightfirsttime.co.uk/wp-content/uploads/2018/04/GIRFT-Cardiothoracic-Report-1.pdf. Accessed March 11, 2024.\u003c/li\u003e\n\u003cli\u003eBashir M, Shaw M, Field M, et al. Repair of type A dissection-benefits of dissection rota. \u003cem\u003eAnnals of cardiothoracic surgery\u003c/em\u003e. 2016;5:209-215.\u003c/li\u003e\n\u003cli\u003ePugh D, Grayson P, Basu N, Dhaun N. Aortitis: recent advances, current concepts and future possibilities. \u003cem\u003eHeart\u003c/em\u003e. 2021;107:1620-1629.\u003c/li\u003e\n\u003cli\u003eStone JR, Bruneval P, Angelini A, et al. Consensus statement on surgical pathology of the aorta from the Society for Cardiovascular Pathology and the Association for European Cardiovascular Pathology: I. Inflammatory diseases. \u003cem\u003eCardiovascular pathology\u003c/em\u003e. 2015;24:267-278.\u003c/li\u003e\n\u003cli\u003eSorriento D, Iaccarino G. Inflammation and Cardiovascular Diseases: The Most Recent Findings. \u003cem\u003eInt J Mol Sci\u003c/em\u003e. 2019;20:3879.\u003c/li\u003e\n\u003cli\u003eBossone E, Eagle KA. Epidemiology and management of aortic disease: aortic aneurysms and acute aortic syndromes. \u003cem\u003eNat Rev Cardiol\u003c/em\u003e. 2021;18:331-348.\u003c/li\u003e\n\u003cli\u003eJahangiri M, Mani K, Acharya M, et al. Early and long-term outcomes of conventional and valve-sparing aortic root replacement. \u003cem\u003eHeart\u003c/em\u003e. 2022;108:1858-1863.\u003c/li\u003e\n\u003cli\u003ePearsall C, Blitzer D, Zhao Y, et al. Long-term outcome of hemiarch replacement in a proximal aortic aneurysm repair: analysis of over 1000 patients. \u003cem\u003eEuropean journal of cardio-thoracic surgery\u003c/em\u003e. 2022;62.\u003c/li\u003e\n\u003cli\u003eGariboldi V, Grisoli D, Kerbaul F, et al. Long-term outcomes after repaired acute type A aortic dissections. \u003cem\u003eInteractive cardiovascular and thoracic surgery\u003c/em\u003e. 2007;6:47-51.\u003c/li\u003e\n\u003cli\u003eJormalainen M, Kes\u0026auml;vuori R, Raivio P, et al. Long-term outcomes after ascending aortic replacement and aortic root replacement for type A aortic dissection. \u003cem\u003eInteract Cardiovasc Thorac Surg\u003c/em\u003e. 2022;34:453-461.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":" \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cdiv class=\"SimplePara\"\u003eDemographics of patient undergoing major aortic surgery.\u003c/div\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003ePatient Demographics\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eN\u0026thinsp;=\u0026thinsp;409\u003c/div\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eAge\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e63 (52, 72)\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eSex (Male)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e277 (68%)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eBMI\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e26.8 (23.9, 30.9)\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eHypercholesterolemia\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e136 (33%)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eDiabetes\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e17 (4.2%)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eHypertension\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e277 (68%)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eSmoking Status\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eCurrent Smoker\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e40 (9.8%)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003ePrevious Smoker\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e132 (32%)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eNever Smoker\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e237 (58%)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003ePrevious Cardiac Surgery\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e26 (6.4%)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eBicuspid Aortic Valve\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e153 (37%)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003ePrevious Type B Dissection\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e8 (2.0%)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eConnective Tissue Disease\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e27 (6.6%)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eArteritis\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e10 (2.4%)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eAortitis\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e46 (11%)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eSystemic Inflammatory Condition\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e15 (3.7%)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003ePrevious Chemotherapy or Radiotherapy\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e4 (1.0%)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003eMedian (IQR); n (%)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003cbr/\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cdiv class=\"SimplePara\"\u003eMortality adjusted for length of follow-up and indication for operation.\u003c/div\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eFollow-Up Time\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eAll-Group Mortality\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003eAneurysm Mortality\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003eTAAD Mortality\u003c/div\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e28 Day Mortality\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e3.9% (n\u0026thinsp;=\u0026thinsp;16/409)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.1% (n\u0026thinsp;=\u0026thinsp;6/289)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e8.3% (n\u0026thinsp;=\u0026thinsp;10/120)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e1 Year Mortality\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e8.1% (n\u0026thinsp;=\u0026thinsp;29/358)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e4.8% (n\u0026thinsp;=\u0026thinsp;12/250)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e15.7% (n\u0026thinsp;=\u0026thinsp;17/108)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e2 Year Mortality\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e9.7% (n\u0026thinsp;=\u0026thinsp;30/308)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e6.5% (n\u0026thinsp;=\u0026thinsp;14/214)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e17.0% (n\u0026thinsp;=\u0026thinsp;16/94)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e3 Year Mortality\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e10.1% (n\u0026thinsp;=\u0026thinsp;26/258)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e6.1% (n\u0026thinsp;=\u0026thinsp;11/179)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e19.0% (n\u0026thinsp;=\u0026thinsp;15/79)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e4 Year Mortality\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e11.7% (n\u0026thinsp;=\u0026thinsp;24/206)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e5.6% (n\u0026thinsp;=\u0026thinsp;8/143)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e25.4% (n\u0026thinsp;=\u0026thinsp;16/63)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e5 Year Mortality\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e14.3% (n\u0026thinsp;=\u0026thinsp;22/154)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e5.5% (n\u0026thinsp;=\u0026thinsp;6/110)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e36.4% (n\u0026thinsp;=\u0026thinsp;16/44)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e6 Year Mortality\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e15.0% (n\u0026thinsp;=\u0026thinsp;16/107)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e6.4% (n\u0026thinsp;=\u0026thinsp;5/78)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e37.9% (n\u0026thinsp;=\u0026thinsp;11/29)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e7 Year Mortality\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e17.3% (n\u0026thinsp;=\u0026thinsp;14/81)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e8.8% (n\u0026thinsp;=\u0026thinsp;5/57)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e37.5% (n\u0026thinsp;=\u0026thinsp;9/24)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e8 Year Mortality\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e18.2% (n\u0026thinsp;=\u0026thinsp;12/66)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e8.3% (n\u0026thinsp;=\u0026thinsp;4/48)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e44.4% (n\u0026thinsp;=\u0026thinsp;8/18)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eTAAD\u0026thinsp;=\u0026thinsp;Type A Aortic Dissection\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003cbr/\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cdiv class=\"SimplePara\"\u003eIndications for re-operations, separated by indication for initial operation.\u003c/div\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eIndication for Re-Operation\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eAll-Group\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003eN\u0026thinsp;=\u0026thinsp;44\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003eAneurysm\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003en\u0026thinsp;=\u0026thinsp;27\u003csup\u003e1\u003c/sup\u003e\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003eTAAD\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003en\u0026thinsp;=\u0026thinsp;17\u003csup\u003e1\u003c/sup\u003e\u003c/div\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eAortic Valve Failure\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e(Native or Replacement)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e6 (14%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e6 (22%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0 (0%)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eGraft Infection\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e11 (25%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e8 (30%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e3 (18%)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003ePseudoaneurysm\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e3 (6.8%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e1 (3.7%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e2 (12%)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eAneurysm\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e21 (48%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e12 (44%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e9 (53%)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eDissection\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e3 (6.8%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0 (0%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e3 (18%)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003en (%), TAAD\u0026thinsp;=\u0026thinsp;Type A Aortic Dissection\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003cbr/\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cdiv class=\"SimplePara\"\u003eUnivariate and multivariate logistic regression for predicators of all cause re-operations from major aortic surgery.\u003c/div\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003eUnivariate\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003eMultivariate\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003ePredictor\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eOR\u003c/span\u003e\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e95% CI\u003c/span\u003e\u003csup\u003e1\u003c/sup\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003ep-value\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eOR\u003c/span\u003e\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e95% CI\u003c/span\u003e\u003csup\u003e1\u003c/sup\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003ep-value\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eIncreased Age\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.97\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.96, 0.99\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.012*\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.96\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.93, 0.99\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.004**\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eMale\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.73\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.39, 1.42\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.341\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.99\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.48, 2.10\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026gt;\u0026thinsp;0.9\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eBMI\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.97\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.90, 1.04\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.357\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.98\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.91, 1.05\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.6\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eHypercholesterolemia\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.56\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.25, 1.13\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.121\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.75\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.31, 1.72\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.5\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eHypertension\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.02\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.53, 2.06\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.945\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.64\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.72, 3.90\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.2\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eCurrent Smoker\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.31\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.93, 5.19\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.053\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.66\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.60, 4.21\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.3\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003ePrevious Smoker\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.77\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.37, 1.50\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.454\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.02\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.46, 2.18\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026gt;\u0026thinsp;0.9\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003ePrevious Cardiac Surgery\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.68\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.11, 2.39\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.604\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.99\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.15, 3.91\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026gt;\u0026thinsp;0.9\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eBicuspid Aortic Valve\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.34\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.14, 0.71\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.007**\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.36\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.14, 0.86\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.027*\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eConnective Tissue Disease\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.59\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.90, 6.47\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.054\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.96\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.26, 3.14\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026gt;\u0026thinsp;0.9\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eArteritis and/or Aortitis\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.79\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.26, 5.82\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.008**\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.71\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.08, 6.54\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.029*\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eSystemic Inflammatory Disease\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e3.22\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.86, 9.91\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.054\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.75\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.67, 9.59\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.13\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003csup\u003e1\u003c/sup\u003eOR = Odds Ratio, CI\u0026thinsp;=\u0026thinsp;Confidence Interval, * = P\u0026thinsp;\u0026lt;\u0026thinsp;0.05, ** = P\u0026thinsp;\u0026lt;\u0026thinsp;0.01\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003cbr/\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cdiv class=\"SimplePara\"\u003eUnivariate and multivariate logistic regression for predicators of re-operations due to aneurysms, dissections, graft infections and pseudoaneurysms.\u003c/div\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003eUnivariate\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003eMultivariate\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003ePredictor\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eOR\u003c/span\u003e\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e95% CI\u003c/span\u003e\u003csup\u003e1\u003c/sup\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003ep-value\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eOR\u003c/span\u003e\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e95% CI\u003c/span\u003e\u003csup\u003e1\u003c/sup\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003ep-value\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eIncreased Age\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.99\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.96, 1.01\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.192\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.97\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.94, 0.99\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.021*\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eMale\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.80\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.40, 1.64\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.528\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.24\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.56, 2.86\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.6\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eBMI\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.99\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.92, 1.06\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.728\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.99\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.92, 1.07\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.9\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eHypercholesterolemia\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.60\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.26, 1.25\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.193\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.69\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.27, 1.65\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.4\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv 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Smoker\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.83\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.13, 6.44\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.018*\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.87\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.66, 4.88\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.2\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003ePrevious Smoker\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.73\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.33, 1.50\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.411\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.02\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.43, 2.32\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026gt;\u0026thinsp;0.9\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003ePrevious Cardiac Surgery\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.80\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.13, 2.86\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.772\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.60\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.24, 6.57\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.6\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eBicuspid Aortic Valve\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.23\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.08, 0.55\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.003**\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.20\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.06, 0.55\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.004**\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eConnective Tissue Disease\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.24\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.28, 3.78\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.736\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.45\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.09, 1.79\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.3\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eArteritis and/or Aortitis\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e3.47\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.55, 7.39\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.002**\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e3.23\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.25, 8.04\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.013*\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eSystemic Inflammatory Disease\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e3.85\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.02, 11.96\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.027*\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.85\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.68, 10.1\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.12\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003csup\u003e1\u003c/sup\u003eOR = Odds Ratio, CI\u0026thinsp;=\u0026thinsp;Confidence Interval, * = P\u0026thinsp;\u0026lt;\u0026thinsp;0.05, ** = P\u0026thinsp;\u0026lt;\u0026thinsp;0.01\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003cbr/\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-cardiothoracic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jcts","sideBox":"Learn more about [Journal of Cardiothoracic Surgery](http://cardiothoracicsurgery.biomedcentral.com)","snPcode":"13019","submissionUrl":"https://submission.nature.com/new-submission/13019/3","title":"Journal of Cardiothoracic Surgery","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Cardiac surgery, aorta, aortic aneurysm, type A aortic dissection, follow-up","lastPublishedDoi":"10.21203/rs.3.rs-4572458/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4572458/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjectives\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThoracic aortic aneurysms and dissections provide a complex surgical cohort termed major aortic surgery. Regular follow-up at specialist clinics with cross-sectional imaging is recommended. Identifying risk factors that lead to re-operations as well as the requirement for and appropriate length of follow-up remain points of debate.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients undergoing any major aortic operation performed at a single centre from January 2012 to December 2022 were retrospectively reviewed. The clinical information, operative details, histological reports, post-operative outcomes and follow up were collected from electronic patient records. Statistical analysis was performed using Microsoft Excel and R Studio.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e409 patients met the inclusion criteria for the study with a median follow-up of 3.8 years (IQR 1.6–7.6). The prevalence of all cause re-operations was 10.8% (n = 44). The median time to re-operation was 1.8 years. 68% of the reoperations occurred within the first 5 years. Multi and univariate logistic regression identified young age, arteritis and/or aortitis as the main risk factors associated with increased risk of re-operation. Connective tissue disease and systemic inflammatory diseases approached but didn’t meet statistical significance. Bicuspid aortic valve pathology was associated with reduced risk of re-operation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients undergoing major-aortic surgery have a high rate of re-operation. The first 5 years represent a high-risk period and follow-up with cross-sectional imaging during that time by specialist aortic services is essential. Patient with aortitis remain at high risk and should be treated by appropriate by specialist aortic services with subspecialty interest and expertise on treating patients with aortitis.\u003c/p\u003e","manuscriptTitle":"Long-Term Outcomes in Major Aortic Surgery: 11 Year Single Centre Experience","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-15 23:41:29","doi":"10.21203/rs.3.rs-4572458/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-07-29T18:33:19+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-16T18:01:13+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-12T02:02:07+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-12T01:43:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"268105154115301837626780863165722941462","date":"2024-07-06T09:58:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"158404519093110343590786195435944626159","date":"2024-07-06T09:33:38+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-05T15:21:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"105796505969033581938963156867828835557","date":"2024-07-04T16:03:17+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-03T02:01:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"124614406682868660257303342033439098036","date":"2024-07-03T00:40:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"49860455930064321604176752839669079392","date":"2024-07-02T08:18:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"83197855297327009274313207017119846894","date":"2024-07-01T14:31:24+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-07-01T09:28:57+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-06-18T00:22:53+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-06-18T00:21:56+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Cardiothoracic Surgery","date":"2024-06-12T21:07:54+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-cardiothoracic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jcts","sideBox":"Learn more about [Journal of Cardiothoracic Surgery](http://cardiothoracicsurgery.biomedcentral.com)","snPcode":"13019","submissionUrl":"https://submission.nature.com/new-submission/13019/3","title":"Journal of Cardiothoracic Surgery","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"dff255c3-1da7-43a0-ac4a-e1e90f0198e7","owner":[],"postedDate":"July 15th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-12-23T16:08:30+00:00","versionOfRecord":{"articleIdentity":"rs-4572458","link":"https://doi.org/10.1186/s13019-024-03153-4","journal":{"identity":"journal-of-cardiothoracic-surgery","isVorOnly":false,"title":"Journal of Cardiothoracic Surgery"},"publishedOn":"2024-12-20 15:58:19","publishedOnDateReadable":"December 20th, 2024"},"versionCreatedAt":"2024-07-15 23:41:29","video":"","vorDoi":"10.1186/s13019-024-03153-4","vorDoiUrl":"https://doi.org/10.1186/s13019-024-03153-4","workflowStages":[]},"version":"v1","identity":"rs-4572458","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4572458","identity":"rs-4572458","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}