Key result
Open total aortic arch replacement in high-risk patients demonstrated an overall in-hospital mortality of 6.9%, permanent stroke rate of 1.7%, and 0% spinal cord injury.
Why the study?
Does open total aortic arch replacement result in acceptable mortality and morbidity in high-risk patients?
Cohort (n=58)
Does open total aortic arch replacement result in acceptable mortality and morbidity in high-risk patients?
Open total aortic arch replacement can be performed with low mortality and morbidity and excellent long-term results even in high-risk patients.
Answers are grounded in this paper and cite their sources.
Open TAR yields low mortality in high-risk patients; leaves open whether hybrid techniques confer advantage.
OBJECTIVES: Open total aortic arch replacement (TAR) in high-risk patients is considered by some to be associated with a prohibitively perioperative risk. Recent reports describe hybrid techniques to treat this group. We reviewed our outcomes of open surgery in a 'high-risk' group of patients. METHODS: All patients who underwent open TAR between 2000 and 2013 were identified from our prospectively maintained database. Patients comparable with the ones who underwent hybrid repair in previous studies (logistic EuroSCORE between 20 and 60 without intervention on the aortic root or on the mitral/tricuspid valve) were selected for analysis. RESULTS: Fifty-eight patients were identified. Median logistic EuroSCORE was 27.4 (range 20-57) and median age was 76 years (34.5% male). There were 11 resternotomies (18.9%) and 20 procedures were urgent/emergency (34.5%). Preoperative comorbidities included chronic obstructive pulmonary disease (31%), coronary artery disease (22.4%), peripheral vascular disease (48.3%), previous stroke (5.2%), previous myocardial infarction (3.4%) and left ventricular dysfunction (12%). Concomitant procedures included aortic valve replacement/resuspension (58.7%), coronary artery bypass grafting (22.4%), open descending aorta replacement (10.3%) and frozen elephant trunk (19%). Overall in-hospital mortality, permanent stroke and spinal cord injury rate were 6.9, 1.7 and 0%, respectively. There were no deaths or stroke in the elective group. One-year, 5-year and 10-year estimates of survival were 82.7, 70.0 and 37.8%, respectively. CONCLUSIONS: Open TAR can be performed with low mortality and morbidity and excellent long-term results even in high-risk patients. Total endovascular repair may represent an option for patients not suitable for open surgery.
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Iafrancesco et al. (2015) conducted a cohort in High-risk patients requiring total aortic arch replacement (n=58). Open total aortic arch replacement was evaluated on Overall in-hospital mortality. Open total aortic arch replacement in high-risk patients demonstrated an overall in-hospital mortality of 6.9%, permanent stroke rate of 1.7%, and 0% spinal cord injury.
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