Elsevier

The Annals of Thoracic Surgery

Volume 86, Issue 5, November 2008, Pages 1518-1523
The Annals of Thoracic Surgery

Original article
Adult cardiac
Incidence, Etiology, Histologic Findings, and Course of Thoracic Inflammatory Aortopathies

https://doi.org/10.1016/j.athoracsur.2008.07.039Get rights and content

Background

The aims of this study were to detect the incidence of thoracic histologically proven aortitis in a large series of 788 patients operated on for thoracic aortic disease, to describe the surgical and histologic features of inflammatory thoracic aortopathies, and to evaluate the frequency of postsurgical complications and mortality.

Methods

Thirty-nine patients (4.9%) were affected by aortitis (mean age, 72.6 ± 9.6). There were 24 women (61.5%). Thirty-four (87.2%) were operated on because of aneurysms and 5 because of dissection. In all cases the diagnosis of aortitis was incidental and was made on the basis of histopathologic findings.

Results

Histologically, there were 30 cases of giant cell aortitis (76.9%), 3 inflammatory aneurysms (7.7%), 2 cases of aspecific lymphoplasmacellular aortitis (5.1%), 1 of Takayasu aortitis, 1 of systemic erythematosus lupus–associated aortitis, and 1 of Behçet's disease–associated aortitis. The only case of infectious aortitis was a syphilitic aortitis. In 79.5% of cases, inflammatory infiltrates were moderate to severe in degree; the most widespread inflammation was seen in Takayasu aortitis, systemic erythematosus lupus–associated aortitis, and in Behçet's disease. The overall in-hospital mortality was 10.3% (4 of 39 patients). Neurologic complications occurred in 4 patients (10.3%).

Conclusions

During surgery of the thoracic aorta, an inflammatory etiology of aneurysms is found in almost 5% of cases. The inflammatory process is in a histologically advanced phase, often with systemic development. Surgery can be associated with high morbidity and mortality.

Section snippets

Patient Population

Between April 1997 and June 2004, we studied specimens of thoracic aorta obtained from 788 patients who underwent thoracic aortic resection. The overall mean age of patients was 58.9 ± 15.24: 449 were me (71.4%; mean age, 56.8 ± 15.17 years) and 180 women (28.6%; mean age, 64.1 ± 14 years). Of these patients, 507 (80.7%) were operated on because of aneurysms and 124 (19.3%) because of dissection.

Thirty-nine patients (4.9%), with a mean age of 72.6 ± 9.6 years and range of 36.6 to 82.1 years,

Histopathologic Features

Histologically, cases of noninfectious aortitis were predominant (38 of 39 patients, 97.4%): 30 cases of giant cell aortitis (GCA; 76.9%; 20 women; median age, 75.9 ± 5.3 years; and 10 men; median age, 74.9 ± 3.9 years), 3 inflammatory aneurysms (7.7%, 2 men; 1 woman; median age, 75.1 ± 3.3 years), 2 cases of aspecific lymphoplasmacellular aortitis (5.1%, 1 woman; 1 male; median age, 60 ± 22.6 years), 1 Takayasu aortitis (2.6%, 48-year-old woman), 1 SLE-associated aortitis (2.6%, woman aged 55

Comment

In our extensive surgical population (n = 788), the incidence of inflammatory aortic disease was 4.9%: this figure is rare but not exceptionally so. This result is different from the data (9% aortitis) reported by Homme and coworkers [8] in their recent paper regarding 513 patients with surgically resected ascending aortic aneurysms.

In our study, women were affected slightly more than men (61.5% versus 38.5%); in most of the data reported in the literature women were more frequently or

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