Abstract Body: Introduction: The impact of aortic inflammation on aortic surgery is still unclear.
Hypothesis: Aortic inflammation affects the freedom from reintervention in the distal native aorta following the aortic arch surgery.
Methods: This is a retrospective observational study performed on the aortic histology of patients over 18 years old who underwent aortic arch surgery in a single centre, from 2000 to 2023. Variables included demographics, cardiovascular risk factors and indication for surgery. The follow-up verified death or reintervention on the distal native aorta. The relationship between aortic inflammation and cardiovascular risk factors was tested with Logistic Regression, expressed as odds ratio (OR) and 95% confidence interval (CI95%). The Cox regression evaluated if inflammation was a significant predictor for mortality and reintervention, expressed as hazard ratio (HR) and 95%CI. The Kaplan-Meier curves for the freedom from reintervention stratified by inflammation were compared with the Tarone-Ware test.
Results: Data concerning 568 patients were gathered: 62(10.9%) had aortic inflammation. The median follow-up was 5.1 years (Interquartile 0.79-8.65 years). The inflammation was independently associated with females (OR2.96 CI95% 1.66-5.28 p<0.01), age (OR1.06 CI95% 1.02-1.09 p<0.01), and aneurysmatic aorta (OR3.81 CI95% 1.29-11.28 p=0.016), but not with aortic dissection (OR0.67 CI95% 0.19-2.32 p=0.53). Inflamed aorta did not increase mortality (HR0.93 CI95% 0.55-1.57 p=0.78). However, inflammation was a risk factor for reintervention on the distal aorta (HR1.9 CI95% 1.04-3.51 p=0.038), especially not feasible with endovascular treatment (HR3.64 CI95% 1.01-13.13 p=0.048) independently from aortic dissection (HR0.82 CI95% 0.55-1.22 p=0.32). The Kaplan-Meier curves confirmed that an inflamed aorta provided lower freedom from reintervention than one without inflammation (Tarone-Ware Test p<0.037).
Conclusions: Aortic inflammation in patients treated with aortic arch surgery is associated with age, female gender, and aneurysmatic pathology. Inflammation doesn’t affect survival after surgery. However, it strongly increases the risk of reintervention in the distal native aorta.