The long-term success of cardiovascular surgery in Takayasu arteritis: 48 years of experience in Mexico, beyond forefront techniques.

BACKGROUND

Takayasu arteritis (TA) affects medium and large caliber arteries causing stenosis, occlusion, or aneurysms. It has great predilection for the aortic arch, subclavian and extracranial arteries. The global prevalence is of 1% to 2% per million inhabitants, which varies by geographical region. The main cause of death in TA of cardiovascular origin and includes ischemic cardiomyopathy and valvular disease. The aim of this study was to evaluate the surgical experience according to the type of surgery in subjects with TA and with and without long-term inflammatory activity.

METHODS

This was a retrospective and descriptive, cross-sectional study, between 1969 and 2017. Patients with TA with more than 3 classification criteria according to the American College of Rheumatology were included. The type of surgery was classified as: organ preservation, cardiac, bypass, exclusion, and replacement. Inflammatory activity was evaluated.

RESULTS

A total of 41 patients were included, out of which 31 (76%) were women. The age at diagnosis was 29±10 years. The long-term survival rate according to the surgical procedure was in cardiac surgery of 15 years in 90% of cases, in organ preservation surgery of 35 years in 90%. Bypass, replacement, exclusion and other surgeries had a 100% survival at a follow-up of 48 years.

CONCLUSIONS

There are different types of surgical approaches to treat the complexity of each TA patient. The surgical technique well selected by experts in cardiothoracic surgery offers an excellent long-term prognosis. Interventional management successfully resolves some arterial occlusive aspects. It is necessary to evaluate the appropriate use of surgical, interventional, and hybrid management through randomized clinical trials to evaluate their comparison with transparency.