The clinical outcomes and histological characteristics of patients undergoing surgery for thoracic aortic aneurysms at a regional referral centre in South Africa

Kirushin Moodley, Mpumelelo Msimang, Kameel Maharaj

Abstract

Background: Thoracic aortic aneurysms (TAA) associated with significant morbidity and mortality worldwide. Determining the clinical outcomes after the surgical repair of TAA and correlation with the histological findings may improve our approach to the disease.
Methods: Patients undergoing surgery for TAA over a seven- year period at a large regional referral centre in South Africa were included. Patient's demographics, surgical intervention, histopathological findings and outcomes were recorded and analysed.
Results: 39 patients were included in the study. The mean age was 48.2±13.7 years. The commonest risk factors were hypertension (41%, n-16), Human Immunodeficiency Virus (HIV) (41%, n-16) and smoking (20.5%, n-8). The 30-day mortality was 12.8% (n = 5) and causes of death were stroke (20%, n = 1), sepsis (20%, n = 1) and low cardiac output state (LCOS) (60%, n = 3). Histology showed cystic medial degeneration (66.7%, n = 26), atherosclerotic plaque (23.1%, n = 9) and active aortitis (10.3%, n = 4). At follow up 24 patients showed clinical improvement with no evidence of TAA recurrence. 10 patients were lost to follow up.
Conclusion: The outcomes of surgery for TAA are not directly correlated with the histological features of the excised aneurysm wall, and are more likely related to patient clinical characteristics and surgical technique.