Predictors of early and late outcome after total arch replacement for atherosclerotic aortic arch aneurysm

• Published in: General thoracic and cardiovascular surgery Vol. 62; no. 1; pp. 31 - 37
• Main Authors: Nakamura, Kunihide, Nagahama, Hiroyuki, Nakamura, Eisaku, Yano, Mitsuhiro, Matsuyama, Masakazu, Nishimura, Masanori, Yokota, Atsuko, Ishii, Hirohito
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01.01.2014; Springer Nature B.V
• Subjects: Aged; Aorta, Thoracic - surgery; Aortic Aneurysm, Thoracic - mortality; Aortic Aneurysm, Thoracic - surgery; Aortic aneurysms; Atherosclerosis; Cardiac Surgery; Cardiology; Cardiovascular disease; Chronic obstructive pulmonary disease; Coronary vessels; Diabetes; Female; Hospital Mortality; Hospitals; Humans; Hypertension; Magnetic resonance imaging; Male; Medical imaging; Medicine; Medicine & Public Health; Middle Aged; Mortality; Multivariate analysis; Original Article; Ostomy; Paralysis; Paraplegia - etiology; Patients; Pneumonia; Postoperative Complications; Prognosis; Risk factors; Stroke; Surgery; Surgical Oncology; Survival Rate; Thoracic Surgery; Vein & artery diseases; Total arch replacement; Outcome; Atherosclerotic aneurysm; Predictors
• ISSN: 1863-6705; 1863-6713
• DOI: 10.1007/s11748-013-0264-y

Objectives This study aimed to identify predictors of early and late outcome after total arch replacement (TAR) for atherosclerotic aortic arch aneurysm. Methods TAR with separate arch vessel grafting and selective cerebral perfusion was performed in 130 patients. The median age at operation was 72.9 ± 6.1 years (57–86 years). Emergency operation was performed in 9 patients (6.9 %) and the frozen elephant trunk technique was used in 51 patients (39.2 %). Results The in-hospital mortality rate was 3.8 %. Chronic renal failure (CRF) was identified as an independent predictor of in-hospital mortality ( p  = 0.0001). Permanent neurological dysfunction occurred in nine patients (6.9 %). Clot or atheroma in the aneurysm ( p  = 0.01) and the duration of selective cerebral perfusion ( p  = 0.011) were identified as independent predictors of permanent neurological dysfunction. Long-term survival rates were 82.0 % at 3 years, 70.0 % at 5 years, and 52.4 % at 8 years postoperatively. CRF ( p  = 0.0190), age ( p  = 0.0147), and permanent neurological dysfunction ( p  = 0.0048) were identified as independent predictors of long-term mortality. Conclusions Prevention of permanent neurological dysfunction is crucial for long-term survival after TAR. Older patients with renal dysfunction may have reduced long-term survival after TAR.