Preoperative Statin Use Not Associated With Improved Outcomes After Ascending Aortic Repair

• Published in: Seminars in thoracic and cardiovascular surgery Vol. 30; no. 4; pp. 421 - 426
• Main Authors: Tyerman, Zachary, Hawkins, Robert B., Mehaffey, James Hunter, Quader, Mohammed, Speir, Alan, Yarboro, Leora T., Ailawadi, Gorav
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-01-2018
• Subjects: Acute Kidney Injury - etiology; Aged; Aortic Aneurysm - diagnostic imaging; Aortic Aneurysm - surgery; Ascending aortic aneurysm; Atrial Fibrillation - etiology; Drug Administration Schedule; Female; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage; Hydroxymethylglutaryl-CoA Reductase Inhibitors - adverse effects; Male; Middle Aged; Outcomes; Registries; Retrospective Studies; Risk Factors; Statins; Treatment Outcome; Vascular Surgical Procedures - adverse effects; Virginia; Virginia; AAA; AF; VCSQI; Ascending aortic aneurysm; LVEF; IQR; Outcomes; LOS; STS; CPB; TAA; ASMD; CLD; MI; Statins; AKI
• ISSN: 1043-0679; 1532-9488
• DOI: 10.1053/j.semtcvs.2018.07.019

Statins have potent pleiotropic effects that have been correlated with improved perioperative cardiovascular surgery outcomes. We hypothesize that statins may improve morbidity and mortality after ascending aortic surgery. Within a statewide database consisting of 19 centers a total of 1804 patients had ascending aortic repair with or without aortic valve replacement (2004–2016). Patients were stratified by preoperative statin therapy for analysis. To account for baseline differences, patients were propensity matched in a 1:1 fashion by baseline characteristics. Patient characteristics and outcomes were analyzed by paired analysis. Of 1804 patients undergoing ascending aortic repair, 35% took statins preoperatively. After matching, 386 patients in each group were well matched with no statistically significant baseline or operative differences. There was no statistically significant difference in outcomes between patients taking statins preoperatively and those not taking statins, including operative mortality (3.6% vs 3.1%, P = 0.68) and major morbidity (18.4% vs 17.1%, P = 0.62). Postoperative atrial fibrillation (27.2% vs 28.5%, P = 0.71) and acute kidney injury (3.1% vs 4.2%, P = 0.41) also showed no statistically significant difference. Statins have no apparent clinical impact on perioperative outcomes after ascending aortic aneurysm repair. Considering recent evidence suggesting statins may increase perioperative risk of acute kidney injury, there is insufficient evidence to recommend starting preoperative statin before ascending aortic repair.