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The Journal of Cardiovascular Surgery 1999 June;40(3):401-5

Copyright © 2000 EDIZIONI MINERVA MEDICA

language: English

Ruptured abdominal aortic aneurysms: Analysis of factors influencing surgical results in 184 patients

Sasaki S., Sakuma M., Samejima M., Kunihara T., Shiiya N., Murashita T., Matsui Y., Yasuda K.

From the Department of Cardiovascular Surgery, Hokkaido University Hospital, Kita-ku, Sapporo, Japan


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Background. Rupture is ­often the ­first man­i­fes­ta­tion in ­patients ­with abdom­i­nal aor­tic aneu­rysms. Although elec­tive sur­gery for non-rup­tured abdom­i­nal aor­tic aneu­rysms has pro­vid­ed sat­is­fac­to­ry sur­gi­cal ­results, oper­a­tive mor­tal­ity of rup­tured abdom­i­nal aor­tic aneu­rysms (rAAA) has not ­improved. The pur­pose of ­this ­study was to iden­ti­fy pre­dic­tors for ear­ly hos­pi­tal ­death in ­patients ­with rAAA.
Methods. Design: A ret­ro­spec­tive ­study. Setting: A uni­ver­sity hos­pi­tal and 20 affil­i­at­ed hos­pi­tals. Patients: Patients under­go­ing sur­gi­cal treat­ment for rAAA (n=183) ­between 1968 and 1997. Interventions: All ­patients ­were sur­gi­cal­ly treat­ed and divid­ed ­into oper­a­tive sur­vi­vors (n=119) and non-sur­vi­vors (n=64). Measures: The ­patient-relat­ed, pro­ce­dure-relat­ed, and post­op­er­a­tive fac­tors ­were com­pared ­between the two ­groups. A mul­ti­var­i­ate anal­y­sis was ­also con­duct­ed to deter­mine pre­dic­tors for hos­pi­tal ­deaths.
Results. In uni­var­i­ate anal­y­sis, age at oper­a­tion (p=0.004), pre­op­er­a­tive hemo­dy­nam­ic con­di­tions (p<0.0001), ­extent of hemat­o­ma (p<0.0001), pre­ex­is­tent ­renal dys­func­tion (p=0.001), and vol­umes of ­blood ­loss at oper­a­tion (p=0.001) ­were sig­nif­i­cant­ly dif­fer­ent ­between the two ­groups. The mor­bid­ity of post­op­er­a­tive ­renal fail­ure (p<0.0001), gut ische­mia (p=0.003), ­heart fail­ure or ischem­ic ­heart dis­ease (p<0.0001), and mul­ti­ple ­organ dys­func­tion syn­drome (p<0.0001) was high­er in the non-­survivors’ ­group. Multivariate anal­y­sis ­also iden­ti­fied pre­op­er­a­tive hemo­dy­nam­ic con­di­tions, ­blood ­loss vol­ume at oper­a­tion, pre­ex­is­tent ­renal dys­func­tion, post­op­er­a­tive ­renal fail­ure, ­heart fail­ure, and mul­ti­ple ­organ dys­func­tion syn­drome as incre­men­tal ­risk fac­tors for hos­pi­tal ­deaths.
Conclusions. Every ­effort to main­tain pre­op­er­a­tive hemo­dy­nam­ic con­di­tions, to ­reduce vol­umes of ­blood ­loss at oper­a­tion, and to min­i­mize dete­ri­ora­tion of ­organ func­tions post­op­er­a­tive­ly is all essen­tial to ­improve ­patient sur­vi­val.

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