Analysis of Postsurgical Aortic False Aneurysm in 27 Patients

Aortic false aneurysm is a rare complication after cardiac surgery. In recent years, improved results have been reported in regard to the surgical management of these high-risk lesions.We retrospectively examined 28 consecutive cases (in 27 patients) of postsurgical aortic false aneurysm diagnosed at our institution from May 1999 through December 2011. Twenty-four patients underwent reoperation. Cardiopulmonary bypass was instituted before sternotomy in 15 patients (63%). Isolated repair of the aortic false aneurysm was performed in 15 patients. Four patients (including one who had already undergone repeat false-aneurysm repair) declined surgery in favor of clinical monitoring.Eleven patients were asymptomatic at the time of diagnosis. In the other 16, the main cause was infection in 7, and previous operation for acute aortic dissection in 9. The in-hospital mortality rate was 16.6% (4 patients, 3 of whom had infective false aneurysms). Relevant postoperative sequelae were noted in 7 patients (29%). The cumulative 1-year and 5-year survival rates were 83% and 62%, respectively. The 4 patients who did not undergo reoperation were alive at a median interval of 23 months (range, 9–37 mo). Two underwent imaging evaluations; in one, computed tomography revealed an 8-mm increase of the false aneurysm''s maximal diameter at 34 months.Aortic false aneurysm can develop silently. Surgical procedures should be proposed even to asymptomatic patients because of the unpredictable evolution of the condition. Radical aortic-graft replacement should be chosen rather than simple repair, because recurrent false aneurysm is possible.Key words: Aortic aneurysm, thoracic/diagnosis/etiology/mortality/prevention&control/radiography/surgery, cardiac surgical procedures/adverse effects, postoperative complications/etiology, recurrence, reoperation/utilizationAortic false aneurysm is a rare sequela of surgery on the thoracic aorta.¹ Infection, pathologic conditions of the aortic wall, dissection of the native aorta, and excessive use of biological glue have been recognized as causative factors.^2,3 The development and expansion of aortic false aneurysms is often silent.³ Their evolution is unpredictable, and rupture can be fatal. Despite advances in endovascular techniques, the treatment is chiefly surgical.⁴ In recent years, improved results in surgical management have been reported^4–6; however, treatment is still burdened by a high morbidity rate.Herein, we provide the midterm results of our experience in the treatment of this challenging pathologic condition, and we discuss the evolution of aortic false aneurysm in patients who declined surgical repair or were deemed unsuitable for reoperation.