Multicentre analysis of current strategies and outcomes in open aortic arch surgery: heterogeneity is still an issue

Abstract

The surgical risk in elective aortic arch surgery has remained high during the last decade despite the advance in surgical techniques. However, the patients' characteristics, numbers of surgeries, the techniques and the results varied considerably among the centres. The incompleteness of data gathered retrospectively was not effective enough to determine advantages of particular cannulation, perfusion, protection or surgical techniques; and therefore, we strongly recommend further prospective multicentre studies, preferably registries, in which all relevant data have to be clearly defined and collected.

Safety of Moderate Hypothermia With Antegrade Cerebral Perfusion in Total Aortic Arch Replacement

“…Risk factors for mortality in this study were consistent with previously known risk factors in aortic surgery. Preoperative shock, the necessity for coronary artery bypass grafting, and prolonged cardiopulmonary bypass time have all been previously described as risk factors for perioperative mortality in other studies [2,15,16]. Risk factors for PND in this study have been similarly well described and included prolonged circulatory arrest.…”

Editor's Choice – Current Options and Recommendations for the Treatment of Thoracic Aortic Pathologies Involving the Aortic Arch: An Expert Consensus Document of the European Association for Cardio-Thoracic Surgery (EACTS) & the European Society for Vascular Surgery (ESVS)

“…76,86 An analysis of open arch surgical strategies at 12 large European centres reported NIRS use for neuromonitoring in all centres. 87 The limitation remains that uneventful intraoperative bifrontal regional cerebral oximetry saturation (rSO 2 ) tracings do not rule out focal cerebral ischaemia, which may occur outside the limited field of view of current NIRS devices. Transcranial Doppler monitoring presents another option to monitor changes in cerebral perfusion but is more complex with regard to the setup and the application during aortic arch surgery.…”

“…246 Currently, there is no robust evidence to recommend minimum caseloads for aortic arch procedures, both open surgery and endovascular repair, either for centres or for individual physicians but a clear volumeeoutcome correlation like in many other cardiovascular procedures supports centralization and specialization. 16,87,247…”

Open aortic arch surgery in chronic dissection with visceral arteries originating from different lumens

“…They argued that this technique is 'less morbid' than conventional aortic replacement through an extended surgical approach, like hemi-clamshell or clamshell incision, emphasizing that none of their patients suffered respiratory complications (reintubation or tracheostomy) and comparing it with the 17% rate of those complications as reported by Kouchoukos after clamshell surgery [17]. Admittedly, the results presented by Roselli et al speak for excellent intensive care at Cleveland, but they can also be partially fortunate and fortuitous because the recent observation of more than 1200 elective patients who underwent complete arch replacement through median sternotomy at 11 European centres revealed a need for reintubation and/or tracheostomy with a rate of 21% as one of the most frequent postoperative complications [18]. Moreover, the Roselli's approach is connected with a weakening of the aorta at the site of the longitudinal incision through the aortic wall consisting of an adventitial layer only.…”