Abstract Body: Background: The impact of aortic wall inflammation on postoperative outcomes after aortic surgery remains unclear and is not addressed in current guidelines.
Hypothesis: Aortic inflammation contributes to adverse aortic pathology outcomes.
Aim: To determine whether aortic wall inflammation influences outcomes after aortic surgery.
Methods: We conducted a retrospective and prospective single center study on adult patients undergoing aortic surgery between 2000–2023. Active infection was excluded. All aortic histology specimens were analyzed and classified according to consensus criteria. Variables included demographics, cardiovascular risk factors, and surgical indication. Primary endpoints were death or reintervention on the remnant native aorta. Associations between inflammation and risk factors were evaluated using logistic regression (OR, 95%CI). Cox regression assessed the impact on primary outcomes (HR, 95%CI). Kaplan–Meier curves stratified by inflammation were compared with the Tarone Ware test.
Results: Among 2465 patients, 230 (9%) had aortic inflammation. Subtypes included: giant cell (74%), lymphoplasmacytic (14%), IgG4 related (8%), and mixed patterns (9%). The prevalence of aortic inflammation increased over the years. Median follow up was 5 years. Inflammation was independently associated with age (OR 1.05, 95%CI 1.01–1.08, p<0.01), female sex (OR 3.5, 95%CI 1.9–6.2, p<0.01), and aneurysmal disease (OR 1.08, 95%CI 1.05–1.1, p<0.01), but not dissection (OR 0.47, 95%CI 0.19–1.10, p=0.08). Inflammation strongly increased the risk of reintervention (HR 2.85, 95%CI 1.8–4.4, p<0.01) and showed a trend toward higher mortality (HR 1.47, 95%CI 0.9–2.2, p=0.053). No differences were observed across inflammatory subtypes. Kaplan–Meier analysis confirmed reduced freedom from reintervention in inflamed aortas (p<0.001).
Conclusions: Aortic wall inflammation is associated with age, female sex, and aneurysmal aortic pathology, and significantly increases the risk of reintervention on the remaining native aorta.