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Post-operative outcomes of inflammatory thoracic aortitis: a study of 41 patients from a cohort of 1119 surgical cases

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Abstract

Aortitis is found in 2–12% of thoracic aortic aneurysm repair/replacement surgeries. Yet little is known about such patients’ post-operative outcomes or the role of post-operative corticosteroids. The study was undertaken across three tertiary referral hospitals in Sydney, Australia. Prospectively collected data for all thoracic aortic repair/replacement patients between 2004 and 2018 was accessed from a national surgical registry and analysed. Histopathology records identified cases of inflammatory aortitis which were subclassified as clinically isolated aortitis (CIA), giant cell arteritis (GCA), Takayasu (TAK) or other aortitis. Between-group outcomes were compared utilising logistic and median regression analyses. Between 2004 and 2018, a total of 1119 thoracic aortic surgeries were performed of which 41 (3.7%) were inflammatory aortitis cases (66% CIA, 27% GCA, 5% TAK, 2% other). Eight out of 41 (20%) aortitis patients received post-operative corticosteroids. Compared to non-aortitis patients, the aortitis group was predominantly female (53.7% vs. 28.1%, p < 0.01), was older (mean 70 vs. 62 years, p < 0.01) and had higher prevalence of hypertension (82.9% vs. 67.1%, p = 0.03) and pre-operative immunosuppression (9.8% vs. 1.4%, p < 0.01). There was no difference (p > 0.05) between aortitis and non-aortitis groups for 30-day mortality (7.3% vs 6.5%), significant morbidity (14.6% vs. 22.4%), or infection (9.8% vs. 6.4%). Outcomes were similar for the non-corticosteroid-treated aortitis subgroup. Histologic evidence of inflammatory thoracic aortitis following surgery did not affect post-operative mortality or morbidity. Withholding corticosteroids did not adversely affect patient outcomes. These findings will assist rheumatologists and surgeons in the post-operative management of aortitis.

Key Points

• Forty-one cases of aortitis were identified from 1119 thoracic aortic repair/replacement surgeries.

• Post-operative mortality, morbidity and resource utilisation were the same for aortitis and non-aortitis patients.

• Withholding corticosteroid therapy post-operatively did not influence outcomes for aortitis patients.

• Aortitis patients were older, had a female predominance and had higher prevalence of hypertension.

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Fig. 1

Data Availability

The data underlying this article cannot be shared publicly due to the privacy of the patients involved and the restrictions placed in the associated ethics approval. The data will be shared on reasonable request to the corresponding author.

Code availability

Not applicable.

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Author information

Authors and Affiliations

  1. Rheumatology Department, Prince of Wales Hospital, Randwick, NSW, 2031, Australia

    Hugh C. Caterson & Anthony M. Sammel

  2. Boden Initiative, Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia

    Ang Li

  3. Rheumatology Department, Royal North Shore Hospital, St. Leonards, NSW, Australia

    Lyn March

  4. Cardiothoracic Surgery Department, Royal Prince Alfred Hospital, Camperdown, NSW, Australia

    Paul G. Bannon

  5. Cardiothoracic Surgery Department, Royal North Shore Hospital, St. Leonards, NSW, Australia

    David Marshman

  6. Cardiothoracic Surgery Department, Prince of Wales Hospital, Randwick, NSW, Australia

    Hugh D. Wolfenden

  7. Anatomical Pathology Department, Royal Prince Alfred Hospital, Camperdown, NSW, Australia

    James Kench

  8. Anatomical Pathology Department, Prince of Wales Hospital, Randwick, NSW, Australia

    Trent Davidson

  9. Anatomical Pathology Department, Royal North Shore Hospital, St. Leonards, NSW, Australia

    Hwei-Choo Soh

Authors
  1. Hugh C. Caterson
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  2. Ang Li
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  3. Lyn March
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  4. Paul G. Bannon
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  6. Hugh D. Wolfenden
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  7. James Kench
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  8. Trent Davidson
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  9. Hwei-Choo Soh
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  10. Anthony M. Sammel
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Contributions

All authors contributed to the research conception and design. Hugh Caterson, Anthony Sammel, James Kench, Hwei-Choo Soh and Trent Robinson performed data collection and interpretation. Statistical analyses were performed by Hugh Caterson and Ang Li. All authors contributed significantly to the manuscript and read and approved the final submission.

Corresponding author

Correspondence to Hugh C. Caterson.

Ethics declarations

Ethics approval

The research was carried out in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. The research was approved by the Human Research Ethics Committee of the South East Sydney Local Health District.

Consent to participate and for publication

All patients provided informed consent for the collection of their data and for its use in publications in a deidentified manner.

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None.

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Data from this manuscript has previously been published in the proceedings of the 2021 EULAR conference: Caterson H, Li A, March L, Bannon P, Kench J, Davidson T, Soh HC, Sammel A, 2021, 'POS0804 OUTCOMES OF SURGICALLY RESECTED THORACIC AORTITIS: RESULTS FROM A PROSPECTIVE MULTI-CENTRE REGISTRY', Annals of the Rheumatic Diseases, vol. 80, pp. 654.2—655

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Caterson, H.C., Li, A., March, L. et al. Post-operative outcomes of inflammatory thoracic aortitis: a study of 41 patients from a cohort of 1119 surgical cases. Clin Rheumatol 41, 1219–1226 (2022). https://doi.org/10.1007/s10067-021-05978-z

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  • DOI: https://doi.org/10.1007/s10067-021-05978-z

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