Total surgical aortic arch replacement as a safe strategy to treat complex multisegmental proximal thoracic aortic pathology.

Czerny, Martin; König, Tobias; Reineke, David Christian; Sodeck, Gottfried H.; Rieger, Maximilian; Schönhoff, Florian; Basciani, Reto Marco; Jenni, Hansjörg; Schmidli, Jürg; Carrel, Thierry (2013). Total surgical aortic arch replacement as a safe strategy to treat complex multisegmental proximal thoracic aortic pathology. Interactive cardiovascular and thoracic surgery, 17(3), pp. 532-536. Oxford University Press 10.1093/icvts/ivt260

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OBJECTIVE

To analyse the results after elective open total aortic arch replacement.

METHODS

We analysed 39 patients (median age 63 years, median logistic EuroSCORE 18.4) who underwent elective open total arch replacement between 2005 and 2012.

RESULTS

In-hospital mortality was 5.1% (n = 2) and perioperative neurological injury was 12.8% (n = 5). The indication for surgery was degenerative aneurysmal disease in 59% (n = 23) and late aneurysmal formation following previous surgery of type A aortic dissection in 35.9% (n = 14); 5.1% (n = 2) were due to anastomotical aneurysms after prior ascending repair. Fifty-nine percent (n = 23) of the patients had already undergone previous proximal thoracic aortic surgery. In 30.8% (n = 12) of them, a conventional elephant trunk was added to total arch replacement, in 28.2% (n = 11), root replacement was additionally performed. Median hypothermic circulatory arrest time was 42 min (21-54 min). Selective antegrade cerebral perfusion was used in 95% (n = 37) of patients. Median follow-up was 11 months [interquartile range (IQR) 1-20 months]. There was no late death and no need for reoperation during this period.

CONCLUSIONS

Open total aortic arch replacement shows very satisfying results. The number of patients undergoing total arch replacement as a redo procedure and as a part of a complex multisegmental aortic pathology is high. Future strategies will have to emphasize neurological protection in extensive simultaneous replacement of the aortic arch and adjacent segments.

Item Type:	Journal Article (Original Article)
Division/Institute:	04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic and Policlinic for Anaesthesiology and Pain Therapy 04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Heart Surgery
UniBE Contributor:	Reineke, David Christian, Schönhoff, Florian, Basciani, Reto Marco, Schmidli, Jürg, Carrel, Thierry
Subjects:	600 Technology > 610 Medicine & health
ISSN:	1569-9293
Publisher:	Oxford University Press
Language:	English
Submitter:	Jeannie Wurz
Date Deposited:	19 Jun 2014 09:07
Last Modified:	27 Feb 2024 14:29
Publisher DOI:	10.1093/icvts/ivt260
PubMed ID:	23788196
Uncontrolled Keywords:	Aneurysm, Aortic arch surgery, Dissection, Multisegmental thoracic, aortic pathology
URI:	https://boris.unibe.ch/id/eprint/53891