POS0804 OUTCOMES OF SURGICALLY RESECTED THORACIC AORTITIS: RESULTS FROM A PROSPECTIVE MULTI-CENTRE REGISTRY
Authors: H. Caterson, A. Li, L. March, P. Bannon, J. Kench, T. Davidson, H. C. Soh, A. Sammel
Journal: Annals of the Rheumatic Diseases (2021)

Background: Inflammatory thoracic aortitis is a cause of aneurysm and is often diagnosed incidentally following aortic replacement surgery. It may be due to systemic diseases such as giant cell arteritis (GCA) and Takayasu arteritis (TAK) or a topographically isolated variant termed clinically isolated aortitis (CIA). While CIA is identified in 2-12% of thoracic aortic surgical pathology, 1 its short-term post-operative outcome is unknown. Objectives: This study was undertaken to examine the short-term post-operative mortality and morbidity of patients with surgically resected thoracic aortitis compared to those with non-inflammatory thoracic aortic aneurysms and assess if outcomes varied based on post-operative corticosteroid therapy. Methods: The study was based at three tertiary referral hospitals in Sydney, Australia, for the years 2004-2018. Prospectively collected data was accessed from a national surgical registry for all patients who underwent thoracic aortic aneurysm replacement. Aortitis patients were identified from histopathology records. Inpatient medical records were reviewed to categorise aortitis cases as CIA, GCA, TAK or other aortitis and to audit the use of corticosteroids. Outcomes were compared between aortitis cases and the non-inflammatory cohort using logistic regressions, controlling for age, sex, year of procedure, and hospital. Results: 41 aortitis cases were identified from the cohort of 1119 surgical patients (3.7%). 27 (66%) met criteria for CIA, 11 (27%) for GCA, 2 (5%) for TAK, and 1 (2%) for Other. 8 (20%) received corticosteroid therapy for aortitis. Compared with non-inflammatory patients, the aortitis cohort was predominantly female (54% vs 28%, p &lt; 0.01), older (mean 70 vs 62 years, p &lt; 0.01), and had higher rates of hypertension (83% vs 67%, p = 0.03) and pre-operative immunosuppression (10% vs 1%, p &lt; 0.01). There was no difference (p &gt; 0.05) between the aortitis and the non-aortitis groups for 30-day mortality (7% vs 7%), composite significant morbidity (15% vs 22%), composite infection (10% vs 6%), return to theatre for bleeding (7% vs 13%), stroke (5% vs 5%) or readmission (12% vs 10%). Similar results were also seen for CIA and the aortitis subgroup who did not receive corticoid steroid therapy when compared to the non-aortitis group (table 1). Table 1. 30-day mortality and morbidity Non-aortitis All aortitis Aortitis, not treated for aortitis CIA n=1078 n=41 n=33 n=27 % n % n % n % n Mortality 7 70 7 3 6 2 4 1 Stroke 5 57 5 2 6 2 4 1 Return to theatre bleed 13 137 7 3 6 2 4 1 Composite morbidity 22 241 15 6 15 5 11 3 Composite infection 6 69 10 4 9 3 11 3 Readmission 10 108 12 5 12 4 11 3 Note: Differences in outcomes between the aortitis groups and the no aortitis group were modelled using logistic regression, controlling for age, sex, year of procedure, and hospital. There were no statistically significant differences in outcomes (p &gt; 0.05). CIA; clinically isolated aortitis. Composite morbidity; an outcome comprised of return to theatre for bleeding, stroke, new renal failure, acute myocardial infarction or aortic dissection. Composite infection; an outcome comprised of 30-day pneumonia, septicaemia, deep sternal wound infection or deep thoracotomy infection. Conclusion: The finding of thoracic aortitis following aortic replacement surgery does not affect short-term post-operative mortality or morbidity. Corticosteroid therapy in the immediate post-operative period did not impact upon short-term outcomes. References: [1]Quimson L, Mayer A, Capponi S, et al . Comparison of aortitis versus noninflammatory aortic aneurysms among patients who undergo open aortic aneurysm repair. Arthritis Rheum 2020;72:1154-59. Disclosure of Interests: None declared