OBJECTIVES: To assess early and long-term outcomes in a large cohort of patients undergoing open aortic arch surgery. METHODS: From 1996 to 2012, 623 consecutive patients (mean age: 62.8 years) underwent aortic arch interventions in our institution. Of these, 208 (33.4%) presented with an acute aortic syndrome (AAS) and 415 (66.6%) with a chronic aortic pathology (CAP). During the study period, our surgical strategy involved extensive resections of the diseased aortic tissue at elective interventions, and a tear-oriented aortic replacement in patients with acute dissection. More extensive interventions were often performed in younger patients, and in those with connective tissue diseases and bicuspid aortic valves. A total arch replacement was frequently performed (53.3%). Antegrade selective cerebral perfusion was used in all cases. RESULTS: Overall in-hospital mortality was 23.1% in patients with AAS and 11.1% in patients with a CAP; in the same groups, postoperative permanent neurological dysfunction (PND) occurred in 9.6 and 5.6%, respectively. The follow-up was 94.4% complete. For in-hospital survivors, 5- and 10-year survival (%) were 79.4 ± 2.1 and 60.9 ± 3.2, respectively, not influenced by the underlying aortic disease. Cox regression identified age (hazard ratio [HR]: 1.048; P < 0.001), preoperative renal failure (HR: 2.3; P = 0.003), diabetes (HR: 1.805; P = 0.005) and PND (HR: 2.4; P = 0.03) to be independent predictors for the follow-up mortality. Overall, 109 (59% endovascular) aortic reinterventions were performed: 18.3% were proximal and 81.7% distal to the aortic arch. Five- and 10-year freedom from aortic redo (%) were 82.8 ± 1.9 and 77.7 ± 2.6, respectively. Aortic dissection (HR: 1.7; P = 0.03) was the only independent predictor of reoperative surgery at the follow-up. CONCLUSIONS: Aortic arch surgery was associated with satisfactory early and long-term outcomes. Survival was largely determined by patient comorbidities and postoperative PND. While the underlying aortic disease did not affect long-term mortality, chronic dissection was associated with increased need for aortic reinterventions.

Long-term outcomes after aortic arch surgery: Results of a study involving 623 patients / Di Eusanio, Marco; Berretta, Paolo; Cefarelli, Mariano; Castrovinci, Sebastiano; Folesani, Gianluca; Alfonsi, Jacopo; Pantaleo, Antonio; Murana, Giacomo; Di Bartolomeo, Roberto. - In: EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY. - ISSN 1010-7940. - STAMPA. - 48:3(2015), pp. 483-490. [10.1093/ejcts/ezu468]

Long-term outcomes after aortic arch surgery: Results of a study involving 623 patients

DI EUSANIO, MARCO;BERRETTA, PAOLO;CEFARELLI, MARIANO;CASTROVINCI, SEBASTIANO;FOLESANI, GIANLUCA;ALFONSI, JACOPO;PANTALEO, ANTONIO;MURANA, GIACOMO;DI BARTOLOMEO, ROBERTO
2015

Abstract

OBJECTIVES: To assess early and long-term outcomes in a large cohort of patients undergoing open aortic arch surgery. METHODS: From 1996 to 2012, 623 consecutive patients (mean age: 62.8 years) underwent aortic arch interventions in our institution. Of these, 208 (33.4%) presented with an acute aortic syndrome (AAS) and 415 (66.6%) with a chronic aortic pathology (CAP). During the study period, our surgical strategy involved extensive resections of the diseased aortic tissue at elective interventions, and a tear-oriented aortic replacement in patients with acute dissection. More extensive interventions were often performed in younger patients, and in those with connective tissue diseases and bicuspid aortic valves. A total arch replacement was frequently performed (53.3%). Antegrade selective cerebral perfusion was used in all cases. RESULTS: Overall in-hospital mortality was 23.1% in patients with AAS and 11.1% in patients with a CAP; in the same groups, postoperative permanent neurological dysfunction (PND) occurred in 9.6 and 5.6%, respectively. The follow-up was 94.4% complete. For in-hospital survivors, 5- and 10-year survival (%) were 79.4 ± 2.1 and 60.9 ± 3.2, respectively, not influenced by the underlying aortic disease. Cox regression identified age (hazard ratio [HR]: 1.048; P < 0.001), preoperative renal failure (HR: 2.3; P = 0.003), diabetes (HR: 1.805; P = 0.005) and PND (HR: 2.4; P = 0.03) to be independent predictors for the follow-up mortality. Overall, 109 (59% endovascular) aortic reinterventions were performed: 18.3% were proximal and 81.7% distal to the aortic arch. Five- and 10-year freedom from aortic redo (%) were 82.8 ± 1.9 and 77.7 ± 2.6, respectively. Aortic dissection (HR: 1.7; P = 0.03) was the only independent predictor of reoperative surgery at the follow-up. CONCLUSIONS: Aortic arch surgery was associated with satisfactory early and long-term outcomes. Survival was largely determined by patient comorbidities and postoperative PND. While the underlying aortic disease did not affect long-term mortality, chronic dissection was associated with increased need for aortic reinterventions.
2015
Long-term outcomes after aortic arch surgery: Results of a study involving 623 patients / Di Eusanio, Marco; Berretta, Paolo; Cefarelli, Mariano; Castrovinci, Sebastiano; Folesani, Gianluca; Alfonsi, Jacopo; Pantaleo, Antonio; Murana, Giacomo; Di Bartolomeo, Roberto. - In: EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY. - ISSN 1010-7940. - STAMPA. - 48:3(2015), pp. 483-490. [10.1093/ejcts/ezu468]
Di Eusanio, Marco; Berretta, Paolo; Cefarelli, Mariano; Castrovinci, Sebastiano; Folesani, Gianluca; Alfonsi, Jacopo; Pantaleo, Antonio; Murana, Giacomo; Di Bartolomeo, Roberto
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11585/545599
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