Open aortic arch reconstruction after previous cardiac surgery: Outcomes of 168 consecutive operations

Eduard Quintana, Pietro Bajona, Hartzell V Schaff, Joseph A. Dearani, Richard C. Daly, Kevin L. Greason, Alberto Pochettino

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Objective Open arch interventions after previous cardiac surgery are considered high risk. We reviewed our outcomes in patients requiring aortic arch reconstruction after previous cardiovascular surgery.

Results The mean age was 61 ± 14 years, and 119 were men (70%). The indications for reoperation were aneurysm (57%), valvular disease (13%), impending rupture (12%), aortic dissection (9.0%), and endocarditis (7.7%). The median time from the previous operation to reoperation was 7 years. The mean aortic diameter was 55 mm. Total or partial arch replacement was performed in 38% and 62% of patients, respectively. Fifty-five patients (32.7%) had undergone previous ascending dissection repair and 45 (26.8%) had previous coronary bypass surgery. Deep hypothermic circulatory arrest was used in all. Selective cerebral perfusion was used in 39% and retrograde cerebral perfusion in 14%. The incidence of permanent stroke was 5.4%. Operative mortality (30-day) was 8.3%. Older age (odds ratio, 1.05; 95% confidence interval, 1.00-1.10; P =.04), New York Heart Association class III/IV (odds ratio, 3.15; 95% confidence interval, 1.01-9.86; P =.04), and extracorporeal circulation time (odds ratio, 1.01; 95% confidence interval, 1.00-1.02; P =.001) were predictors of perioperative death. The median follow-up was 3.0 years. Survival was 85%, 78%, and 68% at 1, 3, and 5 years, respectively.

Conclusions Reoperations to address the aortic arch have acceptable mortality and morbidity. Open repair under circulatory arrest is the benchmark to which endovascular therapies should be compared.

Original languageEnglish (US)
Pages (from-to)2944-2950
Number of pages7
JournalJournal of Thoracic and Cardiovascular Surgery
Volume148
Issue number6
DOIs
StatePublished - Dec 1 2014

Fingerprint

Thoracic Aorta
Reoperation
Thoracic Surgery
Odds Ratio
Confidence Intervals
Dissection
Perfusion
Deep Hypothermia Induced Circulatory Arrest
Benchmarking
Aortic Rupture
Extracorporeal Circulation
Mortality
Endocarditis
Aneurysm
Stroke
Morbidity
Survival
Incidence
Therapeutics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine
  • Medicine(all)

Cite this

Open aortic arch reconstruction after previous cardiac surgery : Outcomes of 168 consecutive operations. / Quintana, Eduard; Bajona, Pietro; Schaff, Hartzell V; Dearani, Joseph A.; Daly, Richard C.; Greason, Kevin L.; Pochettino, Alberto.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 148, No. 6, 01.12.2014, p. 2944-2950.

Research output: Contribution to journalArticle

Quintana, Eduard ; Bajona, Pietro ; Schaff, Hartzell V ; Dearani, Joseph A. ; Daly, Richard C. ; Greason, Kevin L. ; Pochettino, Alberto. / Open aortic arch reconstruction after previous cardiac surgery : Outcomes of 168 consecutive operations. In: Journal of Thoracic and Cardiovascular Surgery. 2014 ; Vol. 148, No. 6. pp. 2944-2950.
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abstract = "Objective Open arch interventions after previous cardiac surgery are considered high risk. We reviewed our outcomes in patients requiring aortic arch reconstruction after previous cardiovascular surgery.Results The mean age was 61 ± 14 years, and 119 were men (70{\%}). The indications for reoperation were aneurysm (57{\%}), valvular disease (13{\%}), impending rupture (12{\%}), aortic dissection (9.0{\%}), and endocarditis (7.7{\%}). The median time from the previous operation to reoperation was 7 years. The mean aortic diameter was 55 mm. Total or partial arch replacement was performed in 38{\%} and 62{\%} of patients, respectively. Fifty-five patients (32.7{\%}) had undergone previous ascending dissection repair and 45 (26.8{\%}) had previous coronary bypass surgery. Deep hypothermic circulatory arrest was used in all. Selective cerebral perfusion was used in 39{\%} and retrograde cerebral perfusion in 14{\%}. The incidence of permanent stroke was 5.4{\%}. Operative mortality (30-day) was 8.3{\%}. Older age (odds ratio, 1.05; 95{\%} confidence interval, 1.00-1.10; P =.04), New York Heart Association class III/IV (odds ratio, 3.15; 95{\%} confidence interval, 1.01-9.86; P =.04), and extracorporeal circulation time (odds ratio, 1.01; 95{\%} confidence interval, 1.00-1.02; P =.001) were predictors of perioperative death. The median follow-up was 3.0 years. Survival was 85{\%}, 78{\%}, and 68{\%} at 1, 3, and 5 years, respectively.Conclusions Reoperations to address the aortic arch have acceptable mortality and morbidity. Open repair under circulatory arrest is the benchmark to which endovascular therapies should be compared.",
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AU - Quintana, Eduard

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AU - Daly, Richard C.

AU - Greason, Kevin L.

AU - Pochettino, Alberto

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N2 - Objective Open arch interventions after previous cardiac surgery are considered high risk. We reviewed our outcomes in patients requiring aortic arch reconstruction after previous cardiovascular surgery.Results The mean age was 61 ± 14 years, and 119 were men (70%). The indications for reoperation were aneurysm (57%), valvular disease (13%), impending rupture (12%), aortic dissection (9.0%), and endocarditis (7.7%). The median time from the previous operation to reoperation was 7 years. The mean aortic diameter was 55 mm. Total or partial arch replacement was performed in 38% and 62% of patients, respectively. Fifty-five patients (32.7%) had undergone previous ascending dissection repair and 45 (26.8%) had previous coronary bypass surgery. Deep hypothermic circulatory arrest was used in all. Selective cerebral perfusion was used in 39% and retrograde cerebral perfusion in 14%. The incidence of permanent stroke was 5.4%. Operative mortality (30-day) was 8.3%. Older age (odds ratio, 1.05; 95% confidence interval, 1.00-1.10; P =.04), New York Heart Association class III/IV (odds ratio, 3.15; 95% confidence interval, 1.01-9.86; P =.04), and extracorporeal circulation time (odds ratio, 1.01; 95% confidence interval, 1.00-1.02; P =.001) were predictors of perioperative death. The median follow-up was 3.0 years. Survival was 85%, 78%, and 68% at 1, 3, and 5 years, respectively.Conclusions Reoperations to address the aortic arch have acceptable mortality and morbidity. Open repair under circulatory arrest is the benchmark to which endovascular therapies should be compared.

AB - Objective Open arch interventions after previous cardiac surgery are considered high risk. We reviewed our outcomes in patients requiring aortic arch reconstruction after previous cardiovascular surgery.Results The mean age was 61 ± 14 years, and 119 were men (70%). The indications for reoperation were aneurysm (57%), valvular disease (13%), impending rupture (12%), aortic dissection (9.0%), and endocarditis (7.7%). The median time from the previous operation to reoperation was 7 years. The mean aortic diameter was 55 mm. Total or partial arch replacement was performed in 38% and 62% of patients, respectively. Fifty-five patients (32.7%) had undergone previous ascending dissection repair and 45 (26.8%) had previous coronary bypass surgery. Deep hypothermic circulatory arrest was used in all. Selective cerebral perfusion was used in 39% and retrograde cerebral perfusion in 14%. The incidence of permanent stroke was 5.4%. Operative mortality (30-day) was 8.3%. Older age (odds ratio, 1.05; 95% confidence interval, 1.00-1.10; P =.04), New York Heart Association class III/IV (odds ratio, 3.15; 95% confidence interval, 1.01-9.86; P =.04), and extracorporeal circulation time (odds ratio, 1.01; 95% confidence interval, 1.00-1.02; P =.001) were predictors of perioperative death. The median follow-up was 3.0 years. Survival was 85%, 78%, and 68% at 1, 3, and 5 years, respectively.Conclusions Reoperations to address the aortic arch have acceptable mortality and morbidity. Open repair under circulatory arrest is the benchmark to which endovascular therapies should be compared.

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