Key result
The debranching technique for total arch replacement showed similar 10-year survival compared to the island technique (78% vs 80.9%; HR 1.18, 95% CI 0.73-1.89, P=0.495).
Why the study?
The branched graft (debranching) and en bloc (island) techniques are both accepted for supra-aortic vessel reimplantation in total arch replacement, motivating an evaluation of their short- and long-term outcomes.
Does the debranching technique compared to the island technique improve short- and long-term outcomes in patients undergoing total arch replacement?
Cohort (n=426)
No
Does the debranching technique compared to the island technique improve short- and long-term outcomes in patients undergoing total arch replacement?
Hazard Ratio: 1.18 (95% CI 0.73–1.89)
Absolute Event Rate: 78% vs 80.9%
p-value: p=0.495
The debranching and island techniques for total arch replacement yield similar early and long-term survival, with preoperative comorbidities rather than surgical technique predicting major adverse events.
Comparable outcomes with either technique support individualized selection in total arch replacement; leaves open optimal approach pending prospective trials.
Objective The 2 most acceptable techniques for reimplantation of the supra-aortic vessels in total arch replacement include the branched graft technique (debranching) or en bloc technique (island). We aim to review our experience with total arch replacement and report short- and long-term outcomes from a high-volume center dedicated to surgery for the thoracic aorta. Methods The aortic surgery database was queried to identify all consecutive patients undergoing total arch replacement between 1997 and 2022. Of the 426 patients who underwent total arch replacement, 303 (71%) received the island technique and 123 (29%) received the debranching approach. Operative and long-term outcomes were compared using multivariable models. Results The debranching group was younger (64 ± 14 years vs 69 ± 12 years, P = .001), had undergone more previous cardiac operations (54.5% vs 27.4%, P < .001), and had more connective tissue disorder (20.3% vs 4.6%, P < .001). The debranching approach was associated with longer total circulatory arrest time (47 ± 15 minutes vs 37 ± 10 minutes, P < .001) and cardiac ischemic time (116 ± 41 minutes vs 100 ± 37 minutes, P < .001). More patients in the debranching group received blood products intraoperatively or postoperatively (56.1% vs 42.9%, P = .018). All other early outcomes did not differ between groups. Overall operative mortality was 1.4% (2.4% vs 1%, P = .486); the incidence of major postoperative complications was 6.3% (5.7% vs 6.6%, P = .897). Ten-year survival was 80% (78% vs 80.9%, log-rank P = .356). Multivariable Cox regression analysis demonstrated that neither surgical approach was associated with survival advantage (hazard ratio, 1.18; 0.73-1.89; P = .495). Conclusions Debranching requires a longer operative time, with similar early and long-term outcomes. Preoperative comorbidity, not surgical technique, predicts major adverse events and long-term survival.
No takes yet. Share an insight, caveat, or question.
Ram et al. (2023) conducted a cohort in Thoracic aortic disease requiring total arch replacement (n=426). Branched graft technique (debranching) vs. En bloc technique (island) was evaluated on 10-year survival (HR 1.18, 95% CI 0.73-1.89, p=0.495). The debranching technique for total arch replacement showed similar 10-year survival compared to the island technique (78% vs 80.9%; HR 1.18, 95% CI 0.73-1.89, P=0.495).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: