Clinical characteristics and risk factors for fatal outcome of patients receiving Sun's procedure after previous cardiac surgery

Guang-Long Sun; Li-Zhong Sun; Jun-Ming Zhu; Yong-Min Liu; Yi-Peng Ge; Shi-Jun Xu

doi:10.1016/j.asjsur.2020.03.014

Clinical characteristics and risk factors for fatal outcome of patients receiving Sun's procedure after previous cardiac surgery

Asian J Surg. 2021 Jan;44(1):87-92. doi: 10.1016/j.asjsur.2020.03.014. Epub 2020 Apr 30.

Authors

Guang-Long Sun¹, Li-Zhong Sun², Jun-Ming Zhu³, Yong-Min Liu³, Yi-Peng Ge³, Shi-Jun Xu³

Affiliations

¹ Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, 100029, Beijing, China.
² Department of Cardiovascular Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Disease, 100029, Beijing, China. Electronic address: lizhongsun@foxmail.com.
³ Department of Cardiovascular Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Disease, 100029, Beijing, China.

PMID: 32360296
DOI: 10.1016/j.asjsur.2020.03.014

Abstract

Background: Cardiac reoperation has always been a difficult problem in clinical practice. Because of the difficulty of operation, the incidence of complications and mortality rate is high. Secondary aortic surgery, especially the reoperation involving arch, has higher risk and is more difficult for patients with renal failure. Sun's operation (total arch replacement + stent elephant nose) has achieved good results in the treatment of diseases involving aortic arch, and occupies an important position in the treatment of patients with secondary arch lesions after cardiac surgery.

Methods: A total of 395 patients with a history of cardiac surgery were recorded in our center from January 1, 2009 to December 31, 2017, among whom 118 (30.1%) patients underwent aortic reoperation via the original incision using Sun's aortic procedure owing to postoperative great vessel disease. We analyzed the clinical data and survival time, and used Cox regression to analyze the risk factors for 30-day mortality as well as long term mortality.

Results: The interval between the last operation and the present operation was 0.08-19 years. Sixteen patients died within 30 days after operation and the average mortality rate was 13.6%. During the follow-up period, 28 patients died, with the mortality rate of 23.7%. As of December 31, 2017, the longest survival time was 9.36 years, and the survival time of 70 patients was more than 3.05 years. The main risk factor associated with the 30-day survival was cardiopulmonary bypass (CPB) time. The longer the CPB time was, the greater the risk of death was. The main risk factors associated with the long-term survival were CPB time and 24-h bleeding volume. The longer the CPB time was, the more the 24-h bleeding volume was, the higher long-term mortality rate was.

Conclusion: The second Sun's operation, as a surgical treatment after cardiac surgery, showed a high survival rate, with long survival time and good curative effect. CPB is the main risk factor for the 30-day survival state after operation, and CPB time and 24-h bleeding volume are the main risk factors for the long-term survival state after operation.

Keywords: Clinical characteristic; Risk factors; Sun's procedure; Survival analysis.

MeSH terms

Adult
Aorta, Thoracic / surgery*
Blood Vessel Prosthesis Implantation / methods*
Blood Vessel Prosthesis Implantation / mortality*
Cardiac Surgical Procedures*
Cardiopulmonary Bypass / adverse effects
Cardiopulmonary Bypass / mortality
Cardiovascular Diseases / surgery*
Female
Humans
Male
Middle Aged
Postoperative Hemorrhage
Reoperation / mortality*
Risk Factors
Stents*
Survival Rate
Time Factors