Contemporary results of open aortic arch surgery

Mathew Thomas, Zhuo Li, David J. Cook, Kevin L. Greason, Thoralf M. Sundt

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Objectives: The success of endovascular therapies for descending thoracic aortic disease has turned attention toward stent graft options for repair of aortic arch aneurysms. Defining the role of such techniques demands understanding of contemporary results of open surgery. Methods: The outcomes of open arch procedures performed on a single surgical service from July 1, 2001 to August 30, 2010, were examined as defined per The Society of Thoracic Surgeons national database. Results: During the study period, 209 patients (median age, 65 years; range, 26-88) underwent arch operations, of which 159 were elective procedures. In 65 the entire arch was replaced, 22 of whom had portions of the descending thoracic aorta simultaneously replaced via bilateral thoracosternotomy. Antegrade cerebral perfusion was used in 78 patients and retrograde cerebral perfusion in 1. Operative mortality was 2.5% in elective circumstances and 10% in emergency cases (P = .04). The stroke rate was 5.0% when procedures were performed electively and 11.8% when on an emergency basis (P = .11). Procedure-specific mortality rates were 5.5% for elective and 10% for emergency procedures with total arch replacement, and 1.0% for elective and 10% for emergency procedures with hemiarch replacement. Stratified by extent, neurologic event rates were 5.5% for elective and 10% for emergency procedures with total arch and 4.8% for elective and 12.5% for emergency procedures with hemiarch replacement. Conclusions: Open aortic arch replacement can be performed with low operative mortality and stroke rates, especially in elective circumstances, by a team with particular focus on the procedure. The results of novel endovascular therapies should be benchmarked against contemporary open series performed in such a setting.

Original languageEnglish (US)
Pages (from-to)838-844
Number of pages7
JournalJournal of Thoracic and Cardiovascular Surgery
Volume144
Issue number4
DOIs
StatePublished - Oct 2012

Fingerprint

Thoracic Aorta
Emergencies
Mortality
Perfusion
Stroke
Thoracic Diseases
Aortic Diseases
Aortic Aneurysm
Nervous System
Stents
Databases
Transplants
Therapeutics

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Thomas, M., Li, Z., Cook, D. J., Greason, K. L., & Sundt, T. M. (2012). Contemporary results of open aortic arch surgery. Journal of Thoracic and Cardiovascular Surgery, 144(4), 838-844. https://doi.org/10.1016/j.jtcvs.2011.09.069

Contemporary results of open aortic arch surgery. / Thomas, Mathew; Li, Zhuo; Cook, David J.; Greason, Kevin L.; Sundt, Thoralf M.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 144, No. 4, 10.2012, p. 838-844.

Research output: Contribution to journalArticle

Thomas, M, Li, Z, Cook, DJ, Greason, KL & Sundt, TM 2012, 'Contemporary results of open aortic arch surgery', Journal of Thoracic and Cardiovascular Surgery, vol. 144, no. 4, pp. 838-844. https://doi.org/10.1016/j.jtcvs.2011.09.069
Thomas, Mathew ; Li, Zhuo ; Cook, David J. ; Greason, Kevin L. ; Sundt, Thoralf M. / Contemporary results of open aortic arch surgery. In: Journal of Thoracic and Cardiovascular Surgery. 2012 ; Vol. 144, No. 4. pp. 838-844.
@article{9e356350c1f5484db50ef4f9f939832b,
title = "Contemporary results of open aortic arch surgery",
abstract = "Objectives: The success of endovascular therapies for descending thoracic aortic disease has turned attention toward stent graft options for repair of aortic arch aneurysms. Defining the role of such techniques demands understanding of contemporary results of open surgery. Methods: The outcomes of open arch procedures performed on a single surgical service from July 1, 2001 to August 30, 2010, were examined as defined per The Society of Thoracic Surgeons national database. Results: During the study period, 209 patients (median age, 65 years; range, 26-88) underwent arch operations, of which 159 were elective procedures. In 65 the entire arch was replaced, 22 of whom had portions of the descending thoracic aorta simultaneously replaced via bilateral thoracosternotomy. Antegrade cerebral perfusion was used in 78 patients and retrograde cerebral perfusion in 1. Operative mortality was 2.5{\%} in elective circumstances and 10{\%} in emergency cases (P = .04). The stroke rate was 5.0{\%} when procedures were performed electively and 11.8{\%} when on an emergency basis (P = .11). Procedure-specific mortality rates were 5.5{\%} for elective and 10{\%} for emergency procedures with total arch replacement, and 1.0{\%} for elective and 10{\%} for emergency procedures with hemiarch replacement. Stratified by extent, neurologic event rates were 5.5{\%} for elective and 10{\%} for emergency procedures with total arch and 4.8{\%} for elective and 12.5{\%} for emergency procedures with hemiarch replacement. Conclusions: Open aortic arch replacement can be performed with low operative mortality and stroke rates, especially in elective circumstances, by a team with particular focus on the procedure. The results of novel endovascular therapies should be benchmarked against contemporary open series performed in such a setting.",
author = "Mathew Thomas and Zhuo Li and Cook, {David J.} and Greason, {Kevin L.} and Sundt, {Thoralf M.}",
year = "2012",
month = "10",
doi = "10.1016/j.jtcvs.2011.09.069",
language = "English (US)",
volume = "144",
pages = "838--844",
journal = "Journal of Thoracic and Cardiovascular Surgery",
issn = "0022-5223",
publisher = "Mosby Inc.",
number = "4",

}

TY - JOUR

T1 - Contemporary results of open aortic arch surgery

AU - Thomas, Mathew

AU - Li, Zhuo

AU - Cook, David J.

AU - Greason, Kevin L.

AU - Sundt, Thoralf M.

PY - 2012/10

Y1 - 2012/10

N2 - Objectives: The success of endovascular therapies for descending thoracic aortic disease has turned attention toward stent graft options for repair of aortic arch aneurysms. Defining the role of such techniques demands understanding of contemporary results of open surgery. Methods: The outcomes of open arch procedures performed on a single surgical service from July 1, 2001 to August 30, 2010, were examined as defined per The Society of Thoracic Surgeons national database. Results: During the study period, 209 patients (median age, 65 years; range, 26-88) underwent arch operations, of which 159 were elective procedures. In 65 the entire arch was replaced, 22 of whom had portions of the descending thoracic aorta simultaneously replaced via bilateral thoracosternotomy. Antegrade cerebral perfusion was used in 78 patients and retrograde cerebral perfusion in 1. Operative mortality was 2.5% in elective circumstances and 10% in emergency cases (P = .04). The stroke rate was 5.0% when procedures were performed electively and 11.8% when on an emergency basis (P = .11). Procedure-specific mortality rates were 5.5% for elective and 10% for emergency procedures with total arch replacement, and 1.0% for elective and 10% for emergency procedures with hemiarch replacement. Stratified by extent, neurologic event rates were 5.5% for elective and 10% for emergency procedures with total arch and 4.8% for elective and 12.5% for emergency procedures with hemiarch replacement. Conclusions: Open aortic arch replacement can be performed with low operative mortality and stroke rates, especially in elective circumstances, by a team with particular focus on the procedure. The results of novel endovascular therapies should be benchmarked against contemporary open series performed in such a setting.

AB - Objectives: The success of endovascular therapies for descending thoracic aortic disease has turned attention toward stent graft options for repair of aortic arch aneurysms. Defining the role of such techniques demands understanding of contemporary results of open surgery. Methods: The outcomes of open arch procedures performed on a single surgical service from July 1, 2001 to August 30, 2010, were examined as defined per The Society of Thoracic Surgeons national database. Results: During the study period, 209 patients (median age, 65 years; range, 26-88) underwent arch operations, of which 159 were elective procedures. In 65 the entire arch was replaced, 22 of whom had portions of the descending thoracic aorta simultaneously replaced via bilateral thoracosternotomy. Antegrade cerebral perfusion was used in 78 patients and retrograde cerebral perfusion in 1. Operative mortality was 2.5% in elective circumstances and 10% in emergency cases (P = .04). The stroke rate was 5.0% when procedures were performed electively and 11.8% when on an emergency basis (P = .11). Procedure-specific mortality rates were 5.5% for elective and 10% for emergency procedures with total arch replacement, and 1.0% for elective and 10% for emergency procedures with hemiarch replacement. Stratified by extent, neurologic event rates were 5.5% for elective and 10% for emergency procedures with total arch and 4.8% for elective and 12.5% for emergency procedures with hemiarch replacement. Conclusions: Open aortic arch replacement can be performed with low operative mortality and stroke rates, especially in elective circumstances, by a team with particular focus on the procedure. The results of novel endovascular therapies should be benchmarked against contemporary open series performed in such a setting.

UR - http://www.scopus.com/inward/record.url?scp=84866425665&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84866425665&partnerID=8YFLogxK

U2 - 10.1016/j.jtcvs.2011.09.069

DO - 10.1016/j.jtcvs.2011.09.069

M3 - Article

C2 - 22177097

AN - SCOPUS:84866425665

VL - 144

SP - 838

EP - 844

JO - Journal of Thoracic and Cardiovascular Surgery

JF - Journal of Thoracic and Cardiovascular Surgery

SN - 0022-5223

IS - 4

ER -