Original articles
Cardiovascular
Surgical Treatment of Ascending Aortic Aneurysms in Patients With Giant Cell Aortitis

https://doi.org/10.1016/j.athoracsur.2004.10.039Get rights and content

Background

Giant cell aortitis is a rare cause of ascending aortic aneurysm disease despite giant cell arteritis being a common cause of vasculitis. We evaluated an 8-year experience with surgical repair with regard to preoperative variables, extent of disease, required surgical procedures, and the propensity to develop additional great vessel aneurysms.

Methods

Thirty-seven patients (29 female, 8 male; aged 69.6 ± 9.5 years) were operated on from 1995 to 2002. Ten (27%) patients had a history of steroid treatment for temporal arteritis or polymyalgia rheumatica 8.9 ± 3.9 years before. Nineteen (51%) patients had +3 or +4 aortic regurgitation. Maximal aneurysm size was 6.1 ± 0.8 cm. Thirty (81%) patients underwent polyethylene terephthalate fiber (Dacron) tube graft replacement of the ascending aorta, 4 (11%) had a modified Bentall procedure, 2 (5%) had a valve-sparing aortic root reconstruction, and 1 (3%) had aortorrhaphy. Twenty-two (59%) patients required 22 ± 9 minutes of hypothermic circulatory arrest for hemiarch or complete aortic arch replacement. Twenty-six (70%) patients had concomitant cardiac procedures.

Results

There was no early mortality. Morbidity was reexploration for bleeding in 3 (8%) patients, stroke in 3 (8%), left vocal cord paralysis in 2 (5%), renal failure in 2 (5%), and gastrointestinal bleeding in 1 (3%). Mean follow-up was 2.8 ± 2.3 years. Four-year actuarial survival was 74% (95% confidence interval, 57% to 94%). Other descending or abdominal aortic or great vessel aneurysms occurred in 17 (46%) patients. Four patients had prior aneurysm surgery, 8 are monitored with aneurysms, and 5 underwent repair of an aneurysm in the follow-up period. Of 8 late deaths, 3 were caused by complications of a descending thoracic aneurysm. No patient required replacement of a native aortic valve that was preserved during the initial operative procedure.

Conclusions

Ascending aortic aneurysms caused by giant cell aortitis can involve the aorta from the aortic root through the aortic arch, thus requiring a tailored operative approach. The aortic valve tissue is spared from the pathologic process. Other aneurysms of the aorta and great vessels occur in nearly half of patients. Frequent surveillance of the remaining aorta is mandatory.

Section snippets

Patients

Thirty-seven patients with an aneurysm involving the ascending aorta caused by giant cell aortitis underwent surgery at the Mayo Clinic, Rochester, MN, between January 1995 and December 2002. A retrospective review of our surgical database and patient medical records was performed. Follow-up information was obtained by questionnaire or telephone calls to assess current status of health, medications, and any significant medical events. The primary indication for surgery in all 37 patients was a

Results

Demographics, presenting symptoms, and significant comorbidities are listed in Table 1. Seventeen (45.9%) patients were in New York Heart Association class III or IV. Nineteen (51%) had greater than grade II aortic regurgitation. Moderate mitral and tricuspid regurgitation was documented in 3 patients each. Two patients had significant aortic stenosis. Three patients had a prior thoracoabdominal aneurysm repair, of which 2 patients underwent emergent surgery because of a leaking aneurysm. One

Comment

Giant cell arteritis can effect the entire vascular tree. Lie [10] has documented that in 72 patients with extracranial disease, the ascending aorta and aortic arch were involved in 39% of cases, the subclavian and axillary arteries in 28%, and the femoropopliteal arteries in 18%. Twenty-five percent had associated temporal arteritis. This ratio was similar in our series. Whereas only 8% of patients had biopsy-proven temporal arteritis in the past, a total of 10 (27%) patients had clinical

References (16)

There are more references available in the full text version of this article.

Cited by (61)

  • Isolated Aortitis: Workup and Management

    2023, Rheumatic Disease Clinics of North America
  • Recent advances in the treatment of giant cell arteritis

    2023, Best Practice and Research: Clinical Rheumatology
View all citing articles on Scopus
View full text