TY - JOUR
T1 - Open aortic arch reconstruction after previous cardiac surgery
T2 - Outcomes of 168 consecutive operations
AU - Quintana, Eduard
AU - Bajona, Pietro
AU - Schaff, Hartzell V.
AU - Dearani, Joseph A.
AU - Daly, Richard C.
AU - Greason, Kevin L.
AU - Pochettino, Alberto
PY - 2014/12/1
Y1 - 2014/12/1
N2 - Objective Open arch interventions after previous cardiac surgery are considered high risk. We reviewed our outcomes in patients requiring aortic arch reconstruction after previous cardiovascular surgery.Results The mean age was 61 ± 14 years, and 119 were men (70%). The indications for reoperation were aneurysm (57%), valvular disease (13%), impending rupture (12%), aortic dissection (9.0%), and endocarditis (7.7%). The median time from the previous operation to reoperation was 7 years. The mean aortic diameter was 55 mm. Total or partial arch replacement was performed in 38% and 62% of patients, respectively. Fifty-five patients (32.7%) had undergone previous ascending dissection repair and 45 (26.8%) had previous coronary bypass surgery. Deep hypothermic circulatory arrest was used in all. Selective cerebral perfusion was used in 39% and retrograde cerebral perfusion in 14%. The incidence of permanent stroke was 5.4%. Operative mortality (30-day) was 8.3%. Older age (odds ratio, 1.05; 95% confidence interval, 1.00-1.10; P =.04), New York Heart Association class III/IV (odds ratio, 3.15; 95% confidence interval, 1.01-9.86; P =.04), and extracorporeal circulation time (odds ratio, 1.01; 95% confidence interval, 1.00-1.02; P =.001) were predictors of perioperative death. The median follow-up was 3.0 years. Survival was 85%, 78%, and 68% at 1, 3, and 5 years, respectively.Conclusions Reoperations to address the aortic arch have acceptable mortality and morbidity. Open repair under circulatory arrest is the benchmark to which endovascular therapies should be compared.
AB - Objective Open arch interventions after previous cardiac surgery are considered high risk. We reviewed our outcomes in patients requiring aortic arch reconstruction after previous cardiovascular surgery.Results The mean age was 61 ± 14 years, and 119 were men (70%). The indications for reoperation were aneurysm (57%), valvular disease (13%), impending rupture (12%), aortic dissection (9.0%), and endocarditis (7.7%). The median time from the previous operation to reoperation was 7 years. The mean aortic diameter was 55 mm. Total or partial arch replacement was performed in 38% and 62% of patients, respectively. Fifty-five patients (32.7%) had undergone previous ascending dissection repair and 45 (26.8%) had previous coronary bypass surgery. Deep hypothermic circulatory arrest was used in all. Selective cerebral perfusion was used in 39% and retrograde cerebral perfusion in 14%. The incidence of permanent stroke was 5.4%. Operative mortality (30-day) was 8.3%. Older age (odds ratio, 1.05; 95% confidence interval, 1.00-1.10; P =.04), New York Heart Association class III/IV (odds ratio, 3.15; 95% confidence interval, 1.01-9.86; P =.04), and extracorporeal circulation time (odds ratio, 1.01; 95% confidence interval, 1.00-1.02; P =.001) were predictors of perioperative death. The median follow-up was 3.0 years. Survival was 85%, 78%, and 68% at 1, 3, and 5 years, respectively.Conclusions Reoperations to address the aortic arch have acceptable mortality and morbidity. Open repair under circulatory arrest is the benchmark to which endovascular therapies should be compared.
UR - http://www.scopus.com/inward/record.url?scp=84919971096&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84919971096&partnerID=8YFLogxK
U2 - 10.1016/j.jtcvs.2014.05.087
DO - 10.1016/j.jtcvs.2014.05.087
M3 - Article
C2 - 25152481
AN - SCOPUS:84919971096
SN - 0022-5223
VL - 148
SP - 2944
EP - 2950
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
IS - 6
ER -