OBJECTIVES: This study aimed to identify predictors of early and late outcome after total arch replacement (TAR) for atherosclerotic aortic arch aneurysm. METHODS: TAR with separate arch vessel grafting and selective cerebral perfusion was performed in 130 patients. The median age at operation was 72.9 ± 6.1 years (57-86 years). Emergency operation was performed in 9 patients (6.9 %) and the frozen elephant trunk technique was used in 51 patients (39.2 %). RESULTS: The in-hospital mortality rate was 3.8 %. Chronic renal failure (CRF) was identified as an independent predictor of in-hospital mortality (p = 0.0001). Permanent neurological dysfunction occurred in nine patients (6.9 %). Clot or atheroma in the aneurysm (p = 0.01) and the duration of selective cerebral perfusion (p = 0.011) were identified as independent predictors of permanent neurological dysfunction. Long-term survival rates were 82.0 % at 3 years, 70.0 % at 5 years, and 52.4 % at 8 years postoperatively. CRF (p = 0.0190), age (p = 0.0147), and permanent neurological dysfunction (p = 0.0048) were identified as independent predictors of long-term mortality. CONCLUSIONS: Prevention of permanent neurological dysfunction is crucial for long-term survival after TAR. Older patients with renal dysfunction may have reduced long-term survival after TAR.
OBJECTIVES: This study aimed to identify predictors of early and late outcome after total arch replacement (TAR) for atherosclerotic aortic arch aneurysm. METHODS: TAR with separate arch vessel grafting and selective cerebral perfusion was performed in 130 patients. The median age at operation was 72.9 ± 6.1 years (57-86 years). Emergency operation was performed in 9 patients (6.9 %) and the frozen elephant trunk technique was used in 51 patients (39.2 %). RESULTS: The in-hospital mortality rate was 3.8 %. Chronic renal failure (CRF) was identified as an independent predictor of in-hospital mortality (p = 0.0001). Permanent neurological dysfunction occurred in nine patients (6.9 %). Clot or atheroma in the aneurysm (p = 0.01) and the duration of selective cerebral perfusion (p = 0.011) were identified as independent predictors of permanent neurological dysfunction. Long-term survival rates were 82.0 % at 3 years, 70.0 % at 5 years, and 52.4 % at 8 years postoperatively. CRF (p = 0.0190), age (p = 0.0147), and permanent neurological dysfunction (p = 0.0048) were identified as independent predictors of long-term mortality. CONCLUSIONS: Prevention of permanent neurological dysfunction is crucial for long-term survival after TAR. Older patients with renal dysfunction may have reduced long-term survival after TAR.
Authors: David Spielvogel; Justus T Strauch; Oktavijan P Minanov; Steven L Lansman; Randall B Griepp Journal: Ann Thorac Surg Date: 2002-11 Impact factor: 4.330
Authors: K M Dossche; M A Schepens; W J Morshuis; F E Muysoms; J J Langemeijer; F E Vermeulen Journal: Ann Thorac Surg Date: 1999-06 Impact factor: 4.330
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