Title : An overview of aortic surgery at a tertiary care hospital in Pakistan: Our 7 years of experience
Abstract:
Background: The aorta can be involved in different pathologies, including congenital, syndromic, and acquired disorders, which may need intervention in any form to prevent disasters. The purpose of this study was to review the types of aortic pathologies treated surgically and their outcomes.
Methods: A retrospective review of data collected in a database was conducted at a tertiary care hospital from January 2017 to December 2023. A total of 115 patients operated for different diseases of the aorta in a single centre over a period of 7 years were included. Institutional review board approval was granted. Data was analysed using SPSS 25; variables were recorded in frequency and mean.
Results: The mean age measured 44.9±18.3 years. Most patients were male (83.4%), and the oldest patient was 76 years old. Hypertension was the most common co-morbidity (41.7%). NYHA-III (36.5%) was common severity of presenting complaints. Most cases were elective (82%). Surgery without cardiopulmonary bypass (CPB) was in 52.1%. A few patients (12.7%) had prolonged ventilation with a mean ventilation of 19.9(±22.0) hours. A total of 65.8% required post-operative blood or blood product transfusion. The mean ICU stay was 56.16±44.0 hours. The most commonly performed procedures were coarctation of the aorta repair (31.3%), Combine aortic root (ARR) and ascending aorta replacement (30.4%), followed by abdominal aortic aneurysm (6.9%) with an in-patient mortality of 0%, 11.4% and 0% respectively. The overall In-hospital mortality was 11.3%. Patients undergoing on-pump procedures had 18.2%, whereas those undergoing off-pump procedures had 5% in-patient mortality. Patients diagnosed with aortic dissection had a higher mortality (33.3%) compared to non-dissection pathology (10.4%). Aortic dissection was present in all mortalities of ARR surgery.
Conclusion: Aortic pathology frequently manifests in various anatomical locations, both in elective and emergency scenarios. Although surgical interventions successfully address various aortic pathologies, these procedures are still bound with certain risks. The presence of dissection and emergency presentation is a major risk factor.
Key Words: Aortic surgery, mortality, aortic aneurysm, aortic dissection, endovascular repair
Audience Take Away:
Hypertension, a prevalent comorbidity among our patients, constitutes a significant risk factor. Furthermore, many patients present late in the disease process to the hospital, complicating their management. To address these issues, several measures are recommended. First, enhancing primary care services is crucial to ensure early detection with screening programs and early referral to aortic centers. Second, improving hypertension control through widespread public health initiatives and accessible medical treatment can reduce the incidence and severity of related complications. Lastly improved healthcare accessibility both in terms of training in aortic diseases treatment and rapid transport of acute patients is essential to optimize patient outcomes.
