Open Surgical Repair Remains the Gold Standard for Treating Aortic Arch Pathology.

Abstract

Endovascular arch repair technology is driven in large part by the assumption that open arch operations are high-risk. We wanted to evaluate the clinical results of open arch reconstruction in the modern era in a large group practice. From October 2003 to June 2014, 567 patients underwent aortic arch operations: hemiarch repair was performed in 429 patients (75.7%; group A), total arch repair in 129 (22.7%; group B), and patch repair in the remaining 9 (1.6%). The procedure was an emergency in 88 patients (20.5%) in group A and in 41 patients (31%) in group B. Redo sternotomy after a previous aortic operation was performed in 35 patients (8.2%) in group A and in 28 patients (22%) in group B. Permanent neurologic deficits were diagnosed in 12 patients (2.8%) in group A and in 3 patients (2.4%) in group B. No spinal cord injuries occurred. Mortality at 30 days was 4% (17 patients) in group A and 5.4% (7 patients) in group B. Patients in group A were younger than in group B (mean age, 61.3 vs 63.6 years; p = 0.06). Older age (odds ratio, 1.05; 95% confidence interval, 1.01 to 1.09; p = 0.0087) and extracorporeal circulation time (odds ratio, 1.01; 95% confidence interval, 1 to 1.01; p < 0.001) were predictors of perioperative 30-day mortality. Age (odds ratio, 1.05; 95% confidence interval, 1.01 to 1.08; p = 0.006) was the only predictor for neurologic dysfunction. Survival at 2, 6, and 8 years was 90%, 80%, and 69%, respectively, for group A, and 85%, 70% and 62%, respectively, for group B. These results set a standard against which endovascular technology needs to be compared.