Reoperations on the total aortic arch in 119 patients: short- and mid-term outcomes, focusing on composite adverse outcomes and survival analysis

J Thorac Cardiovasc Surg. 2014 Dec;148(6):2967-72. doi: 10.1016/j.jtcvs.2014.06.095. Epub 2014 Jul 30.


Objectives: To determine the preoperative and perioperative risk factors that significantly predict adverse outcomes after total arch replacement in patients with previous proximal aortic surgery and to analyze patient survival.

Methods: We performed univariate analysis and logistic regression on data extracted from a prospectively maintained database for 119 patients who had undergone total arch operations during a 7.5-year period. All patients had undergone previous proximal aortic surgery. The adverse outcome was defined as a single composite endpoint comprising operative mortality, permanent neurologic deficit, and renal failure necessitating permanent hemodialysis.

Results: The incidence of the composite endpoint was 13.5% (16 of 119 patients). The univariate predictors were preoperative pulmonary disease (P = .010), cardiac ischemia time (P = .032), and cardiopulmonary bypass (CPB) time (P = .073). On multivariate analysis, the following were predictors of the composite endpoint: preoperative pulmonary disease (P = .036), CPB time (P = .039), concomitant coronary artery bypass (P = .0057), previous aortic valve replacement (P = .027), and previous thoracoabdominal aortic aneurysm surgery (P = .057). Multivariate analysis showed that the CPB time predicted mortality (P = .0044), and previous thoracoabdominal aortic aneurysm surgery predicted stroke (P = .034). The overall survival was 85.3% during a median follow-up of 4.76 years (95% confidence interval, 4.2-5.1).

Conclusions: Aortic arch reoperations, although technically demanding, can produce acceptable results. Preoperative pulmonary disease, CPB time, and concomitant coronary artery bypass predicted an adverse outcome. The CPB time predicted mortality, and previous thoracoabdominal aortic surgery predicted stroke.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aorta, Thoracic / surgery*
  • Blood Vessel Prosthesis Implantation / adverse effects*
  • Blood Vessel Prosthesis Implantation / mortality
  • Cardiopulmonary Bypass / adverse effects
  • Coronary Artery Bypass / adverse effects
  • Female
  • Hospital Mortality
  • Humans
  • Kaplan-Meier Estimate
  • Logistic Models
  • Lung Diseases / complications
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Renal Dialysis
  • Renal Insufficiency / etiology
  • Renal Insufficiency / therapy
  • Reoperation
  • Retrospective Studies
  • Risk Factors
  • Stroke / etiology
  • Time Factors
  • Treatment Outcome