Kenji Minatoya1, Yosuke Inoue2, Hiroaki Sasaki2, Hiroshi Tanaka2, Yoshimasa Seike2, Tatsuya Oda2, Atsushi Omura2, Yutaka Iba3, Hitoshi Ogino4, Junjiro Kobayashi2. 1. Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan. Electronic address: minatoya@kuhp.kyoto-u.ac.jp. 2. Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan. 3. Department of Cardiovascular Surgery, Teine-keijinkai Hospital, Sapporo, Japan. 4. Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan.
Abstract
OBJECTIVE: Total arch replacement (TAR) is an established standard surgical procedure. We report >1000 cases of TAR using a 4-branched graft with antegrade cerebral perfusion (ACP) during a 15-year period. METHODS: Since May 2001, 1005 patients who underwent total aortic replacement (mean age 69.8 ± 11.2 years; range, 9-92 years; 744 male) underwent TAR with a 4-branched graft. All surgeries were performed under hypothermia with ACP. There were 252 emergent operations for acute aortic dissection or aneurysm rupture. Concomitant operations included coronary arterial bypass grafting in 196 patients, aortic valve repair or replacement in 64, and aortic root replacements in 38. RESULTS: The operation time was 482 ± 171 minutes, cardiopulmonary time was 254 ± 94 minutes, cardiac ischemia time was 145 ± 51 minutes, ACP time was 160 ± 47 minutes, and lower body circulatory arrest time was 62 ± 16 minutes. The hospital mortality rate was 5.2%. The permanent neurological dysfunction rate was 3.6% and temporary neurological dysfunction rate was 6.4%. There were no spinal cord complications. The 5-year survival rate was 80.7% and 10-year survival rate was 63.1%. Fifteen patients (1.5%) underwent reoperation for the arch grafts because of a pseudoaneurysm (11 patients), hemolysis (3 patients), and infection (1 patient). CONCLUSIONS: TAR using a 4-branched graft with ACP could be accomplished with acceptable short- and long-term results.
OBJECTIVE: Total arch replacement (TAR) is an established standard surgical procedure. We report >1000 cases of TAR using a 4-branched graft with antegrade cerebral perfusion (ACP) during a 15-year period. METHODS: Since May 2001, 1005 patients who underwent total aortic replacement (mean age 69.8 ± 11.2 years; range, 9-92 years; 744 male) underwent TAR with a 4-branched graft. All surgeries were performed under hypothermia with ACP. There were 252 emergent operations for acute aortic dissection or aneurysm rupture. Concomitant operations included coronary arterial bypass grafting in 196 patients, aortic valve repair or replacement in 64, and aortic root replacements in 38. RESULTS: The operation time was 482 ± 171 minutes, cardiopulmonary time was 254 ± 94 minutes, cardiac ischemia time was 145 ± 51 minutes, ACP time was 160 ± 47 minutes, and lower body circulatory arrest time was 62 ± 16 minutes. The hospital mortality rate was 5.2%. The permanent neurological dysfunction rate was 3.6% and temporary neurological dysfunction rate was 6.4%. There were no spinal cord complications. The 5-year survival rate was 80.7% and 10-year survival rate was 63.1%. Fifteen patients (1.5%) underwent reoperation for the arch grafts because of a pseudoaneurysm (11 patients), hemolysis (3 patients), and infection (1 patient). CONCLUSIONS: TAR using a 4-branched graft with ACP could be accomplished with acceptable short- and long-term results.
Authors: Radosław Gocoł; Jarosław Bis; Damian Hudziak; Magda Piekarska; Łukasz Morkisz; Marek A Deja Journal: Kardiochir Torakochirurgia Pol Date: 2021-10-05