Results
Patient
Characteristics and perioperative outcomes for overall cohort
A total of 261 patients are included in this study, of which 149 (57%)
underwent hemiarch and 112 (43%) underwent total arch repair.
Preoperative and operative characteristics are shown in Tables 1
and 2 . In the overall cohort, median age was 60.6 (IQR 52.7 – 70.0)
with a predominance of males, smokers, and those with hypertension.
Acute aortic dissection was the predominant indication for surgery
(66.3%). Those undergoing hemiarch and total arch repair were of
similar age and body mass index (BMI), and had similar frequencies of
hyperlipidemia, chronic obstructive pulmonary disease, chronic dialysis,
previous stroke, and history of heart failure. Those undergoing hemiarch
repair were more likely to be males, have hypertension, diabetes,
peripheral artery disease, a prior myocardial infarction, and dissection
as the operative indication.
Operative characteristics are notable for a similar proportion of
reoperative surgery in both groups (35.7 vs. 25.7%, p=0.16, total arch
vs. hemiarch). Type of proximal aortic repair was likewise similar in
both groups with relatively equal distribution of isolated aortic
replacement (at sinotubular junction), aortic replacement with aortic
valve replacement, and aortic root replacement. Those undergoing
hemiarch replacement were more likely to have an urgent/emergent
operative indication and to have shorter cardiopulmonary bypass, aortic
cross clamp, and antegrade cerebral perfusion times. Cerebral protection
was used with similar frequency in both groups, with axillary
cannulation and antegrade cerebral perfusion predominating in our recent
series. Thirty-one (11.9%) of those undergoing total arch replacement
had and elephant trunk.
In-hospital and 30-day mortality were significantly higher in those
undergoing total arch replacement. In-hospital mortality was 5.4% in
the hemiarch group versus 13.4% in the total arch group (P=0.024).
30-day mortality was 4.7% in the hemiarch group versus 14.3% in the
total arch group (p=0.018). Vocal cord paralysis was more common in the
total arch group, while other perioperative outcomes (use of ECMO,
stroke, paraplegia, reoperation for bleeding, pneumonia, open chest)
were similar between groups.