Single-centre experience in surgery of acute aortic type A dissection and true aortic arch aneurysm

Abstract

A b s t r a c tBackground: Surgery of the aortic arch is challenging. Aim:To assess the results of aortic arch surgery. Methods:Analysis of 172 patients operated on arch dissection (emergency group: 97 patients) or aneurysm (elective group: 75 patients) between 2007 and 2014. Arch surgery was defined as a procedure requiring circumferential anastomosis at the level of the aortic arch or the descending aorta with the use of techniques of brain protection (deep hypothermic circulatory arrest [DHCA] or selective antegrade cerebral perfusion [SACP]) and/or debranching of at least one supra-aortic vessel.Results: Men predominated in both groups (> 70%). Men were younger in the emergency group (55 vs. 66 years; p < 0.008). The operative risk was higher in the emergency group (19.2% vs. 12.5%; p < 0.001). Forty-nine per cent of the patients from the emergency group and 5% from the elective group were operated with antiplatelet therapy (p < 0.001). Extended hemiarch procedure was performed in 79% (n = 77) in the emergency and 76% (n = 57) in the elective group. Total arch replacement was performed in 19 (21%) patients from the emergency and 18 (24%) patients from the elective group. In these patients debranching was performed in 68% of the emergency patients group and in 67% of the elective group. Elephant trunk procedure (classic/frozen) was performed in 53% (n = 10) from the emergency and in 78% (n = 14) of patients from the elective group. Aortic valve sparing surgery was performed in 20% of patients from the emergency and 9% from the elective group (p = 0.063). DHCA was performed in 58% (n = 43) of patients from the elective group and 39% (n = 37) from the emergency group. SACP was performed in 61% (n = 58) of patients from the emergency and 42% (n = 31) from the elective group. Thirty-day mortality in the emergency group reached 33% (n = 32), and in the elective group 15% (n = 11; p = 0.007). In multivariate analysis, predictors of death in the emergency group were: Logistic EuroSCORE above 19.5%, extracorporeal circulation time above 228 min, and postoperative acute renal failure (ARF); and in the elective group: DHCA time above 26 min, rethoracotomy due to bleeding, and ARF. Follow-up was completed in 100% of patients in terms of vital status. The mean follow-up time of the patients from the emergency group was 24.3 ± 27.10 (min 0, max 92) months, and from the elective group 30.3 ± 24.5 (min 0, max 99) months. During the follow-up period all-cause mortality in the emergency group was 43% (n = 42/97), and in the elective group it was 36% (n = 27/75). Conclusions:Early mortality in the emergency group was higher, while long-term mortality did not differ among the groups. Postoperative ARF is a critical predictor of mortality in both groups.

Open aortic arch surgery: 10 years’ single-center experience

“…Despite the fact that patients in group B underwent more complex aortic arch surgery, had more additional coronary and valvular procedures, and more redo procedures, the outcomes were significantly better than in group A. The early mortality of 8.2% is similar to the data reported by Patel et al [15] in their large series of 721 patients, and even better than the early mortality of 15% reported from another Polish center by Hirnle et al [16].…”

“…Meticulous central nervous system protection contributed to the reduction of the stroke rate to 1.6%, which is an excellent result, better than the rates reported by Patel et al [15] (4.8%) and Hirnle et al [16] (9%). This low frequency of stroke is related to the implementation of selective brain perfusion with cerebral oxygenation monitoring in the majority of operated patients (96.7%), whereas DHCA was used in only 2 (3.3%) patients.…”

Untreated distal intimal tears may be associated with paraplegia after total arch replacement and frozen elephant trunk treatment of acute Stanford type A aortic dissection

“…4,[7][8][9] The 30-day mortality in the present results was 10% and was acceptable as compared with the results of other studies. 7,[17][18][19][20][21] The outcome of surgery is associated with surgeons' experience. 1,16 With the experience increasing and surgical techniques being improved, the mortality is expected to decrease.…”