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1. Surgery on the Aorta
Ankri Hakam
Pogram Pendidikan Dokter Spesialis-1 Bedah Toraks Kardiak dan Vaskular
Fakultas Kedokteran Univesitas Indonesia
2023

2. Surgery on the Aorta
• In registry dataset, surgery of aorta is categorized as other in cardiac
procedure
• Therefore it is incorporated in the part of CABG and other, valve and
other, CABG and valve and other and also as other alone.
• Procedure of the aorta can be done in several ways; one way to
describe the aortic procedure combination with other cardiac
surgeries
• The other way is to describe the procedure according to pathology at
various locations

3. The aortic procedure is classified as one from the
following :
• Interposition tube graft
• Tube graft + separate AVR
• Root replacement with composite valve graft
• Root replacement of native valve
• Homograft root replacement
• Autograft root replacement
• Sinus of valsava repair
• Reduction aortoplasty
• Aortic patch graft
• Endovascular stenting

5. Surgery on the aorta: location and procedure (n = 966)

6. Aortic root surgery : Pathology and procedure

7. Aortic root surgery : Pathology and procedure

8. Aortic root surgery : The most performed procedures for the most common pathologies

9. Root replacement wth composite valve is the most performed procedure

10. Ascending aorta surgery: Pathology and procedure

11. Ascending aorta surgery: Pathology and procedure

12. Aortic arch surgery: Pathology and procedure

13. Aortic arch surgery: Pathology and procedure

14. Aortic arch: The performed procedures and the most common pathology

15. Descending aortic surgery: Pathology and procedure

16. Descending aortic surgery: Pathology and procedure

17. Descending aortic : The performed procedures and the most common pathology

18. Abdominal aortic surgery: Pathology and procedure

19. Abdominal aortic surgery: Pathology and procedure

20. Abdominal aorta : The most common pathologies for the three most commonly
performed aortic procedures

22. Aortic: Location procedure and in-hospital mortality

23. Aortic: Location procedure and in-hospital mortality

24. Aortic: Location procedure and in-hospital mortality in calendar year

25. Aortic: Location procedure and in-hospital mortality in calendar year

26. Aortic: Location procedure and average post-operative stay

27. Aortic: Location procedure and average post-operative stay in calendar year

28. Aortic: Location procedure and average post-operative stay in calendar year

29. Aortic root surgery: Mortality of pathologies and procedure

30. Aortic root surgery: Mortality of pathologies and procedure

31. Ascending aorta surgery: Mortality of pathologies and procedure

32. Ascending aorta surgery: Mortality of pathologies and procedure

33. Descending aorta surgery: Mortality of pathologies and procedure

34. Descending aorta surgery: Mortality of pathologies and procedure

35. Abdominal aortic surgery: Mortality of pathologies and procedure

36. Abdominal aortic surgery: Mortality of pathologies and procedure

37. Surgery on the aorta: Patients with multiple locations surgery
Distribution of patients having operation at two locations of aorta

38. Distribution of patients having operation at three and four locations

39. Surgery on the aorta: Distribution of patients with multiple locations

40. Surgery on multiple locations of aorta and in-hospital mortality

41. Surgery on two locations of aorta: in-hospital mortality

42. Surgery on three and four locations of aorta: in-hospital mortality

43. Most common procedures and in-hospital mortality

44. Most common procedures and in-hospital mortality

45. Most common procedures and in-hospital mortality and calendar year

46. Most common procedures and in-hospital mortality and calendar year

47. Aortic pathology and procedures: Pathology of surgery on multiple locations of aorta

48. Aortic pathology and procedures: Pathology of surgery on multiple locations of aorta

49. Multiple locations and pathology

50. Multiple locations and pathology

51. Distribution of aortic pathology and procedures
• Aneurysm is the most common aortic pathology
• Dissection is the second common pathology
• The root replacement with varying procedures is the most common procedure at aortic
root
• the second most common is interposition tube graft.
• Interposition tube graft is most common procedure for aneurysm and dissection at
ascending aorta
• At aortic arch, interposition tube graft is most common procedure for aneurysm and
dissection
• At abdominal aorta, interposition graft is the most common procedure for aneurysm
• Overall, endovascular stenting is used for aortic aneurysm more frequently than for
aortic dissection.

52. Aortic root surgey: Pathology and procedure

53. Aortic root surgery: Pathology distribution

54. Aortic root surgery: Pathology and procedure

55. Ascending aorta surgery: Pathology and procedure

56. Ascending aorta surgery: Pathology distribution

57. Ascending aorta surgery: Pathology and procedure

58. Aortic arch surgery: Pathology and procedure

59. Aortic arch surgery: Pathology distribution

60. Aortic arch surgery: Pathology and procedure

61. Descending aortic surgery: Pathology and procedure

62. Descending aortic surgery: Pathology distribution

63. Descending aortic surgery: Pathology and procedure

64. Abdominal aortic surgery: Pathology and procedure

65. Abdominal aortic surgery: Pathology distribution

66. Abdominal aortic surgery: Pathology and procedure

67. Aorta surgery: Pathology and procedure

68. Surgery on aorta and other post-operative outcome
New heart failure
• Surgery on aorta in single location has lower rate of post-operative
heart failure 3% compared with 6% on 2 locations and 18% for 3
locations
• Overall surgery on aorta has the incidence of post-operative heart
failure of 3,7%.

69. Aortic surgery: Numbers of involved location and new heart failure

70. Aortic surgery: Location and new myocard infarct

71. Aortic surgery: location and new Myocard infarct

72. Aortic surgery: Location and peri-operative myocard infarct

73. Aortic surgery: location and new peri-operative myocard infarct

74. Surgery on aorta and other post-operative outcome
New stroke
• Overall incidence of new stroke rate after surgery on aorta is 5.2%
• The rate incidence depends on the number of locations of aortic
surgery
• The incidence of new stroke is high when the operation involves
aortic arch (12%) and ascending aorta (8%).

75. Aortic surgery: Location and post-operative stroke

76. Aortic surgery: Location and post-operative stroke

77. Aortic surgery: location and new post-operative stroke

78. Aortic surgery: Location and pulmonary complication

79. Surgery on aorta and other post-operative outcome
Renal failure requiring dialysis
• Overall incidence of renal failure requiring dialysis rate after surgery
on aorta is 5%
• The incidence rate of renal failure is high if surgery on aorta is
performed more than two combined locations simultaneously.

80. Aortic surgery: Location and post-operative renal failure: dialysis

81. Aortic surgery: Location and post-operative renal failure: dialysis

82. Aortic surgery: location and new post-operative renal failure: dialysis

83. Surgery on aorta and other post-operative outcome
Re-operation
• Overall incidence of re-operation after surgery on aorta is 5,5%.
• Overall rate of re-operation for bleeding is about 5%, the rate is high
when surgery on aorta involves ascending or arch of aorta

84. Aortic surgery: Location and re-operation for bleeding

85. Aortic surgery: Location and re-operation for bleeding

86. Aortic surgery: Location and re-operation for bleeding

87. Aortic surgery: Location and GI complication

88. Aortic surgery: Location and GI complication

89. Aortic surgery: Location and GI complication

90. Aortic surgery: Location and GI complication

91. Reference
• The Society of Thoracic Surgeons of Thailand. Surgery on the aorta on
: First National Adult Cardiac Surgical Database Report.2023