Reprint of: Reoperations on the total aortic arch in 119 patients: Short- and mid-term outcomes, focusing on composite adverse outcomes and survival analysis

Preventza, Ourania; García, Andrea; Cooley, Denton A.; Tuluca, Alexandra; Simpson, Keith; Bakaeen, Faisal G.; Omer, Shuab; Cornwell, Lorraine D.; Rosengart, Todd K.; Coselli, Joseph S.

doi:10.1016/j.jtcvs.2014.12.035

Cited by 15 publications

(7 citation statements)

References 13 publications

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“…It has been reported that 5-year survival after total arch replacement was 69.3% to 86.7% in 3.3 to 4.5 years of follow-up, and freedom from reoperation was 86.0% to 97.8% at 5 years. 12,[18][19][20][21][22] In comparison to our previous report (5-year survival was 79.6% AE 3.3% and 10-year survival was 71.2% AE 5.0% in 2.4 AE 2.3 years of follow-up, respectively), 7 our present study shows lower survival rates (73.1% AE 1.9% at 5 years and 54.8% AE 2.7% at 10 years). The difference in survival rates between our previous data and the current data can be attributed to our ability to analyze the number and the cause of late deaths more accurately (51 late deaths in our previous report and 190 late deaths in this report) in the longer follow-up period (5.0 AE 4.1 years and 97.1% patients were followed for longer than 1 year).…”

Section: Discussioncontrasting

confidence: 66%

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

Ikeno

Yokawa

Matsueda

et al. 2019

The Journal of Thoracic and Cardiovascular Surgery

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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.

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Section: Discussioncontrasting

confidence: 66%

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

Ikeno

Yokawa

Matsueda

et al. 2019

The Journal of Thoracic and Cardiovascular Surgery

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“… 5 8 Reported rates of operative mortality range between 5 4 and 12%. 7 The observed rate of early mortality in this report was 6.7%, well comparable to other observations. 1 2 3 4 5 6 7 8 Several risk factors for early mortality have been reported, including previous Type A dissection, 5 older age, 3 and advanced NYHA class.…”

Section: Discussionsupporting

confidence: 91%

“… 7 The observed rate of early mortality in this report was 6.7%, well comparable to other observations. 1 2 3 4 5 6 7 8 Several risk factors for early mortality have been reported, including previous Type A dissection, 5 older age, 3 and advanced NYHA class. 3 6 Most of the publications reporting on RAAS found that indeed prolonged CPB time 3 6 7 8 independently predicts operative mortality.…”

Section: Discussionsupporting

confidence: 91%

“…We found that, in patients undergoing reoperative aortic arch surgery, mild systemic hypothermia is safe and produces well-comparable outcomes with reports in deep hypothermia. 1 2 3 4 5 6 7 8 Furthermore, advanced age predicted operative mortality, and congestive heart failure with advanced functional impairment predicted late mortality. We also found that although the reoperation can cure the aortic arch disease, close follow-up of these patients is mandatory, as many of them develop considerable pathology in the downstream aorta.…”

Section: Discussionmentioning

confidence: 99%

“…Reoperative aortic arch surgery (RAAS) after prior cardiac aortic surgery is considered a technically challenging and high-risk procedure for many reasons, due to the danger associated with the repeat sternotomy, an adhesions-related hostile operative field and complex pathology extending to the descending aorta. 1 2 3 4 5 6 7 8 9 Lastly, there is a perceived need for prolonged circulatory arrest for which deep 1 2 3 4 or moderate hypothermia 5 6 7 8 9 is usually used for the brain and organ protection. Some of the well-recognized drawbacks of deep systemic hypothermia include longer cardiopulmonary bypass (CPB) times, severe coagulopathy requiring transfusions, reexplorations for bleeding, and longer intensive care and hospital stays.…”

Section: Introductionmentioning

confidence: 99%

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Reoperative Aortic Arch Surgery under Mild Systemic Hypothermia: Two-Center Experience

et al. 2021

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Background The aim of the study was to assess the indications, surgical strategies, and outcomes after reoperative aortic arch surgery performed generally under mild hypothermia. Methods Ninety consecutive patients (60 males, mean age, 55 ± 16 years) underwent open reoperative aortic arch surgery after previous cardiac aortic surgery. The indications included chronic-progressive arch aneurysm (55.5%), chronic aortic dissection (17.8%), contained arch rupture (16.7%), and graft infection (10%). The reoperation was performed through a repeat sternotomy (96%) or clamshell thoracotomy (4%) using antegrade cerebral perfusion under mild systemic hypothermia (28.9 ± 2.5°C) in all except three patients. Results The surgery comprised hemiarch or total arch replacement in 41 (46%) and 49 (54%) patients, respectively. The distal extension included classic or frozen elephant trunk technique, each in 12 patients, and total descending aorta replacement in 4 patients. Operative mortality was 6 (6.7%) among all patients, with age identified as the only independent predictor of operative mortality (p = 0.05). Permanent and transient neurologic deficits occurred in 1% and 9% of the patients, respectively. Estimated survival at 8 years was 59 ± 8% with advanced heart failure predictive for late mortality (p = 0.014). Freedom from second reoperation or intervention on the aorta was 78 ± 6% at 8 years, with most of these events occurring downstream in patients with chronic degenerative aneurysms. Conclusion Aortic arch reoperations performed using antegrade cerebral perfusion under mild systemic hypothermia offer favorable operative outcomes with an exceptionally low rate of neurologic morbidity without any difference between hemiarch and complex arch procedures.

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