Long-term outcomes of total arch replacement using a 4-branched graft

Abstract

Objective: Our study evaluated the long-term outcomes of total arch replacement using a 4-branched graft.Methods: From October 1999 to December 2016, 655 patients underwent total arch replacement using a 4-branched graft (pathology in the 655 patients was distributed as 399 no dissection, 149 acute dissection, and 107 chronic dissection). Two hundred nine patients (31.9%) underwent nonelective surgery. Mean followup term was 5.0 AE 4.1 years and follow-up rate was 97.1%.Results: Of 655 patients who underwent total arch replacement using a 4-branched graft, operative mortality occurred in 34 patients (5.2%) and permanent neurologic deficit occurred in 24 patients (3.7%). One hundred ninety late deaths occurred, with 20 aortic event-related deaths. Overall survival was 73.1% AE 1.9% at 5 years and 54.8% AE 2.7% at 10 years. Multivariate Cox-hazard regression analysis demonstrated that older age, lower estimated glomerular filtration rate, concurrent procedures, permanent neurologic deficit, tracheostomy, and renal failure were significant risk factors for late death. Freedom from repeat operation on the aorta was 98.0% AE 0.7% at 5 years and 93.9% AE 1.8% at 10 years and freedom from additional aortic operation was 87.2% AE 1.5% at 5 years and 77.3% AE 2.7% at 10 years. The incidence of pseudoaneursym was 2.2%. Conclusions:The long-term outcomes for patients undergoing total arch replacement using 4-branched graft are favorable. However, even in the late phase, periodic follow-up is necessary to address subsequent aorta-related events.

Determinants of outcomes following surgery for type A acute aortic dissection: the UK National Adult Cardiac Surgical Audit

“…While total arch replacement has been consistently shown to be safe in elective surgery, controversy still exists about its impact on surgical mortality and morbidity and its long-term benefit in the setting of TAAAD. 21 Our results confirm the hypothesis that total aortic arch replacement should be undertaken on the basis of the patient preoperative conditions and surgical findings. Compared to other registries, our cohort showed a lower proportion of patients undergoing total arch replacement and this could be attributed to the fact that only few units in the UK currently have a dedicated aortic service delivered by specialist aortic surgeons.…”

Severe systemic inflammatory response syndrome in patients following Total aortic arch replacement with deep hypothermic circulatory arrest

“…The patients undergoing arch repair for aortic pathology had an average age of 40 yr at our institute, younger than those of other investigations, where patients aged 53.9 to 70.1 yr [17–21]. The incidence of emergent status was as greater, at 55.8%, than in previous settings.…”

“…The incidence of emergent status was as greater, at 55.8%, than in previous settings. At two institutes in Japan, the emergency rates were 26.1% [17] and 25.1% [18], respectively, according to recent publications in the field of TAR using a 4-branched graft. The definition of an emergent procedure at our institution was within 24 h prior to surgery, while the precise time was not given in those two single-center experiences.…”

Reply from authors: We still have more to do in our life

“…In another study of 606 patients who had total arch replacement in our institute, 3 risk factors for hospital death were older age, low preoperative estimated glomerular filtration rate, organ malperfusion, and longer cardiopulmonary bypass time. Risk factors for new stroke were severe white matter change seen in brain magnetic resonance imaging, 4 atherosclerotic shaggy aorta, and longer cardiopulmonary bypass time.…”