Characteristics and outcomes of patients with postoperative cardiovascular pseudoaneurysms

Background Data regarding long-term outcomes in cardiovascular pseudoaneurysms are sparse. In patients with prior cardiovascular surgery, we sought to assess characteristics and outcomes in patients with cardiovascular pseudoaneurysms (excluding ischemic left ventricular pseudoaneurysms). Methods We included 114 patients (mean age, 57 ± 16 years; 70% were men) with prior cardiovascular surgery who presented with paravalvular (n = 71, 59 aortic and 12 mitral valve) and ascending aortic (n = 43) pseudoaneurysms (27% with systemic infection). Baseline, surgical, and follow-up data were recorded. A composite end point of stroke or death during follow-up was recorded. Results Additive European System for Cardiac Operative Risk Evaluation was high (10%), and 81% of patients underwent another redo cardiovascular surgery. Over a mean follow-up period of 5.2 ± 4 years, there were 37 (32%) composite events (32 deaths and 5 strokes). Within the surgical subgroup, there were 10 (11%) composite events during the in-hospital stay. The 1-, 2-, 5-, and 10-year freedom from composite events were 86%, 82%, 74%, and 55%, respectively. Additive European System for Cardiac Operative Risk Evaluation (hazard ratio, 1.14) and presence of a documented systemic infection (hazard ratio, 3.90) were associated with a higher rate of composite events, whereas subsequent cardiovascular surgery as a time-dependent covariate hazard ratio (hazard ratio, 0.30) was associated with improved freedom from composite events (all P < .05). Conclusions Patients with a history of cardiovascular surgery in whom cardiovascular pseudoaneurysms subsequently develop have a high rate of short- and long-term adverse events. A higher additive European System for Cardiac Operative Risk Evaluation and documented systemic infection were associated with a higher rate of composite events, whereas cardiovascular surgery (to correct cardiovascular pseudoaneurysms) during follow-up was associated with improved freedom from adverse events.