Open Surgical Repair Remains the Gold Standard for Treating Aortic Arch Pathology

Vishal Khullar, Hartzell V Schaff, Joseph A. Dearani, Richard C. Daly, Kevin L. Greason, Lyle D. Joyce, Alberto Pochettino

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background: Endovascular arch repair technology is driven in large part by the assumption that open arch operations are high-risk. We wanted to evaluate the clinical results of open arch reconstruction in the modern era in a large group practice. Methods: From October 2003 to June 2014, 567 patients underwent aortic arch operations: hemiarch repair was performed in 429 patients (75.7%; group A), total arch repair in 129 (22.7%; group B), and patch repair in the remaining 9 (1.6%). The procedure was an emergency in 88 patients (20.5%) in group A and in 41 patients (31%) in group B. Redo sternotomy after a previous aortic operation was performed in 35 patients (8.2%) in group A and in 28 patients (22%) in group B. Results: Permanent neurologic deficits were diagnosed in 12 patients (2.8%) in group A and in 3 patients (2.4%) in group B. No spinal cord injuries occurred. Mortality at 30 days was 4% (17 patients) in group A and 5.4% (7 patients) in group B. Patients in group A were younger than in group B (mean age, 61.3 vs 63.6 years; . p = 0.06). Older age (odds ratio, 1.05; 95% confidence interval, 1.01 to 1.09; . p = 0.0087) and extracorporeal circulation time (odds ratio, 1.01; 95% confidence interval, 1 to 1.01; . p < 0.001) were predictors of perioperative 30-day mortality. Age (odds ratio, 1.05; 95% confidence interval, 1.01 to 1.08; . p = 0.006) was the only predictor for neurologic dysfunction. Survival at 2, 6, and 8 years was 90%, 80%, and 69%, respectively, for group A, and 85%, 70% and 62%, respectively, for group B. Conclusions: These results set a standard against which endovascular technology needs to be compared.

Original languageEnglish (US)
JournalAnnals of Thoracic Surgery
DOIs
StateAccepted/In press - 2016

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Thoracic Aorta
Pathology
Odds Ratio
Confidence Intervals
Neurologic Manifestations
Technology
Group Practice
Sternotomy
Extracorporeal Circulation
Mortality
Spinal Cord Injuries
Emergencies
Survival

ASJC Scopus subject areas

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

Cite this

Khullar, V., Schaff, H. V., Dearani, J. A., Daly, R. C., Greason, K. L., Joyce, L. D., & Pochettino, A. (Accepted/In press). Open Surgical Repair Remains the Gold Standard for Treating Aortic Arch Pathology. Annals of Thoracic Surgery. https://doi.org/10.1016/j.athoracsur.2016.08.064

Open Surgical Repair Remains the Gold Standard for Treating Aortic Arch Pathology. / Khullar, Vishal; Schaff, Hartzell V; Dearani, Joseph A.; Daly, Richard C.; Greason, Kevin L.; Joyce, Lyle D.; Pochettino, Alberto.

In: Annals of Thoracic Surgery, 2016.

Research output: Contribution to journalArticle

Khullar, Vishal ; Schaff, Hartzell V ; Dearani, Joseph A. ; Daly, Richard C. ; Greason, Kevin L. ; Joyce, Lyle D. ; Pochettino, Alberto. / Open Surgical Repair Remains the Gold Standard for Treating Aortic Arch Pathology. In: Annals of Thoracic Surgery. 2016.
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abstract = "Background: Endovascular arch repair technology is driven in large part by the assumption that open arch operations are high-risk. We wanted to evaluate the clinical results of open arch reconstruction in the modern era in a large group practice. Methods: From October 2003 to June 2014, 567 patients underwent aortic arch operations: hemiarch repair was performed in 429 patients (75.7{\%}; group A), total arch repair in 129 (22.7{\%}; group B), and patch repair in the remaining 9 (1.6{\%}). The procedure was an emergency in 88 patients (20.5{\%}) in group A and in 41 patients (31{\%}) in group B. Redo sternotomy after a previous aortic operation was performed in 35 patients (8.2{\%}) in group A and in 28 patients (22{\%}) in group B. Results: Permanent neurologic deficits were diagnosed in 12 patients (2.8{\%}) in group A and in 3 patients (2.4{\%}) in group B. No spinal cord injuries occurred. Mortality at 30 days was 4{\%} (17 patients) in group A and 5.4{\%} (7 patients) in group B. Patients in group A were younger than in group B (mean age, 61.3 vs 63.6 years; . p = 0.06). Older age (odds ratio, 1.05; 95{\%} confidence interval, 1.01 to 1.09; . p = 0.0087) and extracorporeal circulation time (odds ratio, 1.01; 95{\%} confidence interval, 1 to 1.01; . p < 0.001) were predictors of perioperative 30-day mortality. Age (odds ratio, 1.05; 95{\%} confidence interval, 1.01 to 1.08; . p = 0.006) was the only predictor for neurologic dysfunction. Survival at 2, 6, and 8 years was 90{\%}, 80{\%}, and 69{\%}, respectively, for group A, and 85{\%}, 70{\%} and 62{\%}, respectively, for group B. Conclusions: These results set a standard against which endovascular technology needs to be compared.",
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