Recent advancements of total aortic arch replacement

Abstract

Objective: Recent advancements in total aortic arch replacement achieved by our approach were presented.

Methods: From January 2002 to December 2010, 321 consecutive patients (mean age 69.8 ± 13.3 years) underwent total arch replacement through a median sternotomy at our institute. Aortic dissection was present in 94 (28.3%) patients and shaggy aorta in 36 (11.2%), with emergency/urgent surgery required in 106 (33.0%). Our current approach included the following: (1) meticulous selection of arterial cannulation site and type of arterial cannula; (2) antegrade selective cerebral perfusion; (3) maintenance of minimal tympanic temperature between 20 °C and 23 °C; (4) early rewarming just after distal anastomosis; (5) after 2004, bolus injection of 100 mg of sivelestat sodium hydrate into the pump circuit at the initiation of cardiopulmonary bypass; (6) after 2006, maintaining fluid balance below 1000 mL during cardiopulmonary bypass.

Results: Overall hospital mortality was 4.4% (14/321) and was 1.9% (4/215) in elective cases. Permanent neurologic deficit occurred in 4.4% (14/321) of patients and in 2.8% (6/215) of elective cases. Prolonged ventilation was necessary in 53 (16.5%), with a significant reduction after 2006 (22.8% vs 12.6%; P = .02). Multivariate analysis demonstrated that risk factors for hospital mortality were octogenarian (odds ratio, 4.32; P = .03), brain malperfusion (odds ratio, 21.2; P = .001) and cardiopulmonary bypass time (odds ratio, 1.01; P = .04). Survival at 3 and 5 years after surgery was 82.4% ± 2.5% and 78.5% ± 3.1%, respectively.

Conclusions: Our current approach for total aortic arch replacement was associated with low hospital mortality and morbidities and with favorable long-term outcome.