Faculty Collaboration Database

Open aortic arch replacement in high-risk patients: the gold standard. Eur J Cardiothorac Surg 2016 Feb;49(2):646-51; discussion 651

Date

05/17/2015

Pubmed ID

25979728

DOI

10.1093/ejcts/ezv149

Scopus ID

2-s2.0-84959867443 (requires institutional sign-in at Scopus site)   20 Citations

Abstract

OBJECTIVES: Open total aortic arch replacement (TAR) in high-risk patients is considered by some to be associated with a prohibitively perioperative risk. Recent reports describe hybrid techniques to treat this group. We reviewed our outcomes of open surgery in a 'high-risk' group of patients.

METHODS: All patients who underwent open TAR between 2000 and 2013 were identified from our prospectively maintained database. Patients comparable with the ones who underwent hybrid repair in previous studies (logistic EuroSCORE between 20 and 60 without intervention on the aortic root or on the mitral/tricuspid valve) were selected for analysis.

RESULTS: Fifty-eight patients were identified. Median logistic EuroSCORE was 27.4 (range 20-57) and median age was 76 years (34.5% male). There were 11 resternotomies (18.9%) and 20 procedures were urgent/emergency (34.5%). Preoperative comorbidities included chronic obstructive pulmonary disease (31%), coronary artery disease (22.4%), peripheral vascular disease (48.3%), previous stroke (5.2%), previous myocardial infarction (3.4%) and left ventricular dysfunction (12%). Concomitant procedures included aortic valve replacement/resuspension (58.7%), coronary artery bypass grafting (22.4%), open descending aorta replacement (10.3%) and frozen elephant trunk (19%). Overall in-hospital mortality, permanent stroke and spinal cord injury rate were 6.9, 1.7 and 0%, respectively. There were no deaths or stroke in the elective group. One-year, 5-year and 10-year estimates of survival were 82.7, 70.0 and 37.8%, respectively.

CONCLUSIONS: Open TAR can be performed with low mortality and morbidity and excellent long-term results even in high-risk patients. Total endovascular repair may represent an option for patients not suitable for open surgery.

Author List

Iafrancesco M, Ranasinghe AM, Dronavalli V, Adam DJ, Claridge MW, Riley P, McCafferty I, Mascaro JG

Author

Jorge G. Mascaro MD Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Aged, 80 and over
Aorta, Thoracic
Aortic Diseases
Blood Vessel Prosthesis Implantation
Databases, Factual
Female
Follow-Up Studies
Hospital Mortality
Humans
Male
Middle Aged
Postoperative Complications
Risk
Treatment Outcome