| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
a Division of Cardiovascular Surgery, Mayo Clinic Rochester, Rochester, Minnesota
b Division of Anesthesiology, Mayo Clinic Rochester, Rochester, Minnesota
Accepted for publication May 5, 2008.
* Address correspondence to Dr Sundt, Division of Cardiovascular Surgery, Mayo Clinic, 200 First St, SW, Rochester, MN 55905 (Email: sundt.thoralf{at}mayo.edu).
Presented at the Forty-fourth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 28–30, 2008.
Background: The rapid evolution of endovascular approaches to arch reconstruction such as brachiocephalic debranching and endovascular stent grafting renders an accurate understanding of contemporary outcomes of conventional open arch surgery particularly relevant.
Methods: Cases of arch reconstruction were identified by search of the computerized cardiovascular surgical database. Perioperative (30-day) outcomes as per The Society of Thoracic Surgeons database were evaluated.
Results: Between January 1, 1993, and June 30, 2007, 347 patients (195 male, 152 female; median age, 69 years; range, 21 to 88 years) underwent aortic arch replacement. Procedures were elective in 232 cases. Total arch replacement was performed in 95, including 15 with concomitant replacement of the descending thoracic aorta by means of bilateral thoracosternotomy. Modalities adjunctive to profound hypothermia and circulatory arrest for cerebral protection have been introduced, including retrograde cerebral perfusion and, more recently, selective antegrade cerebral perfusion. The overall mortality rate was 8.9% (elective procedures, 6.0%) and stroke rate was 8.4% (elective procedures, 6.9%). The mortality rate for total arch replacement has declined with adjuncts overall from 34.6% (9 of 26) with profound hypothermia and circulatory arrest to 21.1% (4 of 19) with retrograde cerebral perfusion and to 6.0% (3 of 50) with selective antegrade cerebral perfusion (p < 0.01), and for elective cases from 30.0% (6 of 20) with profound hypothermia and circulatory arrest to 14.3% (2 of 14) with retrograde cerebral perfusion, and 2.7% (1 of 37) with selective antegrade cerebral perfusion (p < 0.01). The corresponding stroke rates were 19.2% (5 of 26) with profound hypothermia and circulatory arrest, 5.3% (1 of 19) with retrograde cerebral perfusion, and 6.0% (3 of 50) with selective antegrade cerebral perfusion (p = 0.18) overall and 15.0% (3 of 20) with profound hypothermia and circulatory arrest, 7.1% (1 of 14) with retrograde cerebral perfusion, and 5.4% (2 of 37) with selective antegrade cerebral perfusion (p = 0.46) for elective cases.
Conclusions: Currently, open aortic arch replacement can be accomplished under elective circumstances with low operative mortality, particularly with adjunctive measures for cerebral protection. The results of endovascular therapies should be measured against contemporary surgical series.
This article has been cited by other articles:
|
|
 |
|
  L. Heim, R. J. Poole, R. Warwick, and M. Poullis The concept of aortic replacement based on computational fluid dynamic analysis: patient-directed aortic replacement Interact CardioVasc Thorac Surg, May 1, 2013; 16(5): 583 - 588. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Yuri, Y. Yokoi, A. Yamaguchi, D. Hori, K. Adachi, and H. Adachi Usefulness of fenestrated stent grafts for thoracic aortic aneurysms Eur J Cardiothorac Surg, March 14, 2013; (2013) ezt127v1. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Canaud, F. Joyeux, V. Ziza, P. Branchereau, C. Marty-Ane, and P. Alric Hemi-aortic arch debranching for hybrid aortic arch repair by sequential transposition of the left common carotid and subclavian arteries J. Thorac. Cardiovasc. Surg., March 1, 2013; 145(3): 764 - 767. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Bavaria, P. Vallabhajosyula, P. Moeller, W. Szeto, N. Desai, and A. Pochettino Hybrid approaches in the treatment of aortic arch aneurysms: Postoperative and midterm outcomes J. Thorac. Cardiovasc. Surg., March 1, 2013; 145(3_suppl): S85 - S90. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Cao, P. De Rango, M. Czerny, A. Evangelista, R. Fattori, C. Nienaber, H. Rousseau, and M. Schepens Systematic review of clinical outcomes in hybrid procedures for aortic arch dissections and other arch diseases J. Thorac. Cardiovasc. Surg., December 1, 2012; 144(6): 1286 - 1300.e2. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Fernandes, A. Cleland, C. Adams, and M. Chu Clinical and biochemical outcomes for additive mesenteric and lower body perfusion during hypothermic circulatory arrest for complex total aortic arch replacement surgery Perfusion, November 1, 2012; 27(6): 493 - 501. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Thomas, Z. Li, D. J. Cook, K. L. Greason, and T. M. Sundt Contemporary results of open aortic arch surgery J. Thorac. Cardiovasc. Surg., October 1, 2012; 144(4): 838 - 844. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. A. Antoniou, A. Schiro, S. A. Antoniou, F. Farquharson, D. Murray, J. V. Smyth, and F. Serracino-Inglott Chimney technique in the endovascular management of complex aortic disease Vascular, October 1, 2012; 20(5): 251 - 261. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Numata, Y. Tsutsumi, O. Monta, S. Yamazaki, H. Seo, R. Sugita, S. Yoshida, and H. Ohashi Aortic Arch Repair With Antegrade Selective Cerebral Perfusion Using Mild to Moderate Hypothermia of More Than 28{degrees}C Ann. Thorac. Surg., July 1, 2012; 94(1): 90 - 96. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Bachet 'If you want to kill your dog, accuse him of having rabies.' (French proverb) Eur J Cardiothorac Surg, January 1, 2012; 41(1): 183 - 184. [Full Text] [PDF]
|
|
|
|
|
|
A. Kulik, C. F. Castner, and N. T. Kouchoukos Outcomes After Total Aortic Arch Replacement With Right Axillary Artery Cannulation and a Presewn Multibranched Graft Ann. Thorac. Surg., September 1, 2011; 92(3): 889 - 897. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. B. Park, K. L. Greason, R. M. Suri, H. I. Michelena, H. V. Schaff, and T. M. Sundt III Should the proximal arch be routinely replaced in patients with bicuspid aortic valve disease and ascending aortic aneurysm? J. Thorac. Cardiovasc. Surg., September 1, 2011; 142(3): 602 - 607. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Lioupis and C. Z. Abraham Results and Challenges for the Endovascular Repair of Aortic Arch Aneurysms Perspectives in Vascular Surgery and Endovascular Therapy, September 1, 2011; 23(3): 202 - 213. [Abstract] [PDF]
|
|
|
|
|
|
E. M. Elmistekawy and F. D. Rubens Deep hypothermic circulatory arrest: Alternative strategies for cerebral perfusion. A review article Perfusion, September 1, 2011; 26(1_suppl): 27 - 34. [Abstract] [PDF]
|
|
|
|
|
|
G. Watanabe, H. Ohtake, S. Tomita, S. Yamaguchi, K. Kimura, and N. Yashiki Tepid hypothermic (32 {degrees}C) circulatory arrest for total aortic arch replacement: a paradigm shift from profound hypothermic surgery Interact CardioVasc Thorac Surg, June 1, 2011; 12(6): 952 - 955. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. A. LeMaire, M. D. Price, J. L. Parenti, M. L. Johnson, A. D. Lay, O. Preventza, J. Huh, and J. S. Coselli Early Outcomes After Aortic Arch Replacement by Using the Y-Graft Technique Ann. Thorac. Surg., March 1, 2011; 91(3): 700 - 708. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Englberger, R. M. Suri, K. L. Greason, H. M. Burkhart, T. M. Sundt III, R. C. Daly, and H. V. Schaff Deep hypothermic circulatory arrest is not a risk factor for acute kidney injury in thoracic aortic surgery J. Thorac. Cardiovasc. Surg., February 1, 2011; 141(2): 552 - 558. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Bavaria, R. K. Milewski, J. Baker, P. Moeller, W. Szeto, and A. Pochettino Classic hybrid evolving approach to distal arch aneurysms: Toward the zone zero solution J. Thorac. Cardiovasc. Surg., December 1, 2010; 140(6_suppl): S77 - S80. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. K. Milewski, W. Y. Szeto, A. Pochettino, G. W. Moser, P. Moeller, and J. E. Bavaria Have hybrid procedures replaced open aortic arch reconstruction in high-risk patients? A comparative study of elective open arch debranching with endovascular stent graft placement and conventional elective open total and distal aortic arch reconstruction J. Thorac. Cardiovasc. Surg., September 1, 2010; 140(3): 590 - 597. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. E. Roselli, E. G. Soltesz, T. Mastracci, L. G. Svensson, and B. W. Lytle Antegrade Delivery of Stent Grafts to Treat Complex Thoracic Aortic Disease Ann. Thorac. Surg., August 1, 2010; 90(2): 539 - 546. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. J. Koullias and G. H. Wheatley III State-of-the-Art of Hybrid Procedures for the Aortic Arch: A Meta-Analysis Ann. Thorac. Surg., August 1, 2010; 90(2): 689 - 697. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Canaud, K. Hireche, J.-P. Berthet, P. Branchereau, C. Marty-Ane, and P. Alric Endovascular repair of aortic arch lesions in high-risk patients or after previous aortic surgery: Midterm results J. Thorac. Cardiovasc. Surg., July 1, 2010; 140(1): 52 - 58. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 WRITING GROUP MEMBERS, L. F. Hiratzka, G. L. Bakris, J. A. Beckman, R. M. Bersin, V. F. Carr, D. E. Casey Jr, K. A. Eagle, L. K. Hermann, E. M. Isselbacher, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine Circulation, April 6, 2010; 121(13): e266 - e369. [Full Text] [PDF]
|
|
|
|
|
|
G. C. Hughes, M. A. Daneshmand, K. R. Balsara, H. A. Achneck, B. Sileshi, S. M. Lee, and R. L. McCann "Hybrid" Repair of Aneurysms of the Transverse Aortic Arch: Midterm Results Ann. Thorac. Surg., December 1, 2009; 88(6): 1882 - 1888. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
