Outcomes: Mortality, Morbidity, and Quality of Life

Aortic surgery can be performed as an elective or emergency procedure. There are various reasons to choose to undergo surgery, which can improve current symptoms or prevent an emergency later. We perform more than 200 major aortic procedures each year at the Aortic Center, including at least 50 specific valve repairs. The majority of these are elective, with excellent outcomes. 

Elective Surgery

Among those who choose to undergo elective surgery, most can return to normal life with a quality and length resembling those without aortic disease.

This return to normal life, however, does come with certain limits. For example, weightlifters can resume weight-training up to 50% of one’s body weight, as more might put undue pressure on the aorta, straining the repair. If you have a connective tissue disorder contributing to your aortic disease, you may have to be careful with contact sports, as you are at a higher risk of joint problems. 

Follow-up monitoring is necessary for all those undergoing surgery. In those with valve-sparing and valve replacement operations, echocardiograms are performed at 6 months and annually following the surgery to monitor aortic health. 

Emergency Surgery 

In the case of aortic dissection where emergency surgery is required, we attempt to reconstruct your aorta, and within reason, you should be able to resume a normal life, including exercise. As part of follow-up care, you should maintain your blood pressure within healthy limits, as the remaining aorta is still at risk for problems. You will need careful follow-up with annual CT scans to monitor the aorta. 

Traditionally, emergency surgery in patients with acute Type A aortic dissection has been associated with significant risk. At the Aortic Center, we previously repaired Type A dissections using traditional surgical methods, which included profound hypothermic circulatory arrest. Beginning in 2008, we altered our strategy to use a specialized technique called antegrade cerebral perfusion. This technique has been shown to reduce the risk of stroke and improve surgical outcomes.  

To give you an idea of our outcomes at the Aortic Center, we have compiled the following numbers: 

All Aortic root replacement (emergency+elective)1

Mortality: 3.7%
All complications, including respiratory failure, wound infection, pericardial effusion (fluid around the heart), stroke, or need for pacemaker: 12%

Aortic root and valve replacement using First Generation Columbia Bioroot 2

Operative mortality: 2.9%

Aortic root and valve replacement using Second Generation Columbia Bioroot 3

Operative mortality: 2.0%
Stroke: 0%

Valve-sparing aortic root replacement 4

Operative mortality in all patients: 0
1-year mortality in patients under age 70: 0
1-year mortality in patients aged 70-80: 6.7%
1-year mortality in patients over age 80: 15.8%

Total aortic arch reconstruction using hybrid endovascular approach, without hypothermic circulatory arrest 5

Mortality: 11%
Mortality in total aortic arch reconstruction using hybrid endovascular approach, with hypothermic circulatory arrest: 18%

Acute aortic dissection with repair using Generation I Columbia Bioroot 6

Operative mortality: 2.9% (patients with acute aortic dissection)


  1. Open distal anastomosis in aortic root replacement using axillary cannulation and moderate hypothermia. - Takayama H; Smith CR; Bowdish ME; Stewart AS - J Thorac Cardiovasc Surg - 01-JUN-2009; 137(6): 1450-3.
  2. Modified Bentall operation with bioprosthetic valved conduit: Columbia University experience. Tabata M; Takayama H; Bowdish ME; Smith CR; Stewart AS - Ann Thorac Surg - 01-JUN-2009; 87(6): 1969-70.
  3. Modified Bentall operation with a novel biologic valved conduit. Stewart AS; Takayama H; Smith CR - Ann Thorac Surg - 01-MAR-2010; 89(3): 938-41.
  4. Safety of Valve-sparing Aortic Root Surgery in Septuagenarians and Octogenarians. Iribarne, A. Presented at the AATS Aortic Symposium in April 2010; currently in press.
  5. Use of carotid-subclavian arterial bypass and thoracic endovascular aortic repair to minimize cerebral ischemia in total aortic arch reconstruction. - Xydas S, Wei B, Takayama H, Russo M, Bacchetta, Smith CR, Stewart AS. - J Thorac Cardiovasc Surg - 01-MAR-2010; 139(3): 717-22; discussion 722.
  6. Modified Bentall operation with bioprosthetic valved conduit: Columbia University experience. Tabata M; Takayama H; Bowdish ME; Smith CR; Stewart AS - Ann Thorac Surg - 01-JUN-2009; 87(6): 1969-70.