Advances in aortic arch surgery.

From 1980 to January 1991, 130 patients (89 men and 41 women, aged 22 to 76 years; mean age, 52 years) underwent 133 interventions on the aortic arch. Aneurysm was diagnosed in 57 patients, whereas 29 had chronic and 44 acute aortic dissection. In 67 instances a partial and in 35 instances a total arch replacement was performed. The distal arch was approached through a left thoracotomy in 14 patients. Local interventions (n = 17) included surgical reconstruction and glue procedures. Additionally, 55 patients required aortic valve replacement, preferably with composite grafts (n = 46), whereas the valve was reconstructed in 14. Procedures were performed using hypothermia (nasopharyngeal temperature, 11 degrees to 25 degrees C) and circulatory arrest (mean time, 27 minutes). Early mortality was 13.9% at the first operation on the aortic arch. Early deaths included 7 of 57 patients with aortic aneurysm (12.3%), 2 of 29 patients with chronic dissection (6.9%), and 9 of 44 patients with acute dissection (20.5%). Neurological (n = 6) and cardiac events (n = 5) were the most common causes of early death. Since 1987, 7 of 88 patients have died for an overall mortality of 8.0%. With growing experience, proper indication, and adequate operative strategy including the use of circulatory arrest in hypothermia, operation on the aortic arch can be performed with an acceptable risk.