Open Surgical Repair Remains the Gold Standard for Treating Aortic Arch Pathology. Ann Thorac Surg 2017 May;103(5):1413-1420
Date
12/05/2016Pubmed ID
27914636DOI
10.1016/j.athoracsur.2016.08.064Scopus ID
2-s2.0-85007484081 (requires institutional sign-in at Scopus site) 43 CitationsAbstract
BACKGROUND: Endovascular arch repair technology is driven in large part by the assumption that open arch operations are high-risk. We wanted to evaluate the clinical results of open arch reconstruction in the modern era in a large group practice.
METHODS: From October 2003 to June 2014, 567 patients underwent aortic arch operations: hemiarch repair was performed in 429 patients (75.7%; group A), total arch repair in 129 (22.7%; group B), and patch repair in the remaining 9 (1.6%). The procedure was an emergency in 88 patients (20.5%) in group A and in 41 patients (31%) in group B. Redo sternotomy after a previous aortic operation was performed in 35 patients (8.2%) in group A and in 28 patients (22%) in group B.
RESULTS: Permanent neurologic deficits were diagnosed in 12 patients (2.8%) in group A and in 3 patients (2.4%) in group B. No spinal cord injuries occurred. Mortality at 30 days was 4% (17 patients) in group A and 5.4% (7 patients) in group B. Patients in group A were younger than in group B (mean age, 61.3 vs 63.6 years; p = 0.06). Older age (odds ratio, 1.05; 95% confidence interval, 1.01 to 1.09; p = 0.0087) and extracorporeal circulation time (odds ratio, 1.01; 95% confidence interval, 1 to 1.01; p < 0.001) were predictors of perioperative 30-day mortality. Age (odds ratio, 1.05; 95% confidence interval, 1.01 to 1.08; p = 0.006) was the only predictor for neurologic dysfunction. Survival at 2, 6, and 8 years was 90%, 80%, and 69%, respectively, for group A, and 85%, 70% and 62%, respectively, for group B.
CONCLUSIONS: These results set a standard against which endovascular technology needs to be compared.
Author List
Khullar V, Schaff HV, Dearani JA, Daly RC, Greason KL, Joyce LD, Pochettino AMESH terms used to index this publication - Major topics in bold
AdolescentAdult
Aged
Aged, 80 and over
Aorta, Thoracic
Aortic Aneurysm, Thoracic
Aortic Rupture
Blood Vessel Prosthesis Implantation
Brain
Brain Damage, Chronic
Brain Ischemia
Cardiopulmonary Bypass
Female
Heart Arrest, Induced
Hospitals, High-Volume
Humans
Hypothermia, Induced
Male
Middle Aged
Postoperative Complications
Reoperation
Retrospective Studies
Sternotomy
Survival Rate
Young Adult
