Brent Keeling1, David Tian2, Heinz Jakob3, Malakh Shrestha4, Takuya Fujikawa5, Joel S Corvera6, Marco Di Eusanio7, Bradley Leshnower8, Edward P Chen8. 1. Division of Cardiothoracic Surgery, Emory University, Atlanta, Georgia. Electronic address: brent.keeling@emory.edu. 2. International Aortic Arch Surgery Study Group, Macquarie Park, Australia. 3. Department of Thoracic and Cardiovascular Surgery, University of Essen, Essen, Germany. 4. Department of Cardiothoracic, Transplantation and Vascular Surgery, University of Hannover, Hannover, Germany. 5. Kawasaki Aortic Center, Kawasaki, Japan. 6. Division of Cardiac and Thoracic Surgery, Indiana University School of Medicine, Indianapolis, Indiana. 7. Department of Cardiac Surgery, Politecnica University of Marche, Ancona, Italy. 8. Division of Cardiothoracic Surgery, Emory University, Atlanta, Georgia.
Abstract
BACKGROUND: During elective aortic arch replacement, the addition of an aortic root procedure has an unknown effect on morbidity and mortality. The purpose of this study is to determine the effect of adding an aortic root procedure to elective aortic surgery using the ARCH international database. METHODS: The ARCH Database was queried for all elective aortic arch replacements with and without aortic root replacement using moderate hypothermic circulatory arrest and antegrade cerebral perfusion from 2000 to 2015. Propensity score matching analysis was used to balance covariates, and a logistic regression model was created. RESULTS: A total of 1,169 patients were included for analysis, and 320 patients (27.4%) underwent an aortic root procedure. Patients undergoing root procedures were younger (69 versus 61 years), had less coronary artery disease (20% versus 32%), and had a higher incidence of Marfan's syndrome (4.2% versus 10.0%) (p < 0.001 for all). Concomitant coronary artery bypass grafting (26.6% versus 19.7%), total aortic arch replacement (41.6% versus 84.3%), and elephant trunk procedures (46% versus 17.2%) were performed more frequently in the nonroot cohort (p < 0.001 for all). Cardiopulmonary bypass and aortic cross-clamp times were significantly longer in the cohort of patients who underwent root procedures, whereas cerebral perfusion times were longer in the nonroot cohort (p < 0.001 for all). In both the propensity matched and nonmatched analyses, postoperative outcomes were not significantly different between patients who underwent root procedures and patients who did not (p > 0.05 for all outcomes). Multivariable logistic regression analyses showed no difference in mortality rates (odds ratio 0.62, 95% confidence interval: 0.9 to 1.34, p = 0.22) or in rates of permanent stroke (odds ratio 0.89, 95% confidence interval: 0.36 to 2.24, p = 0.81) between the root and nonroot cohorts. CONCLUSIONS: The addition of an aortic root procedure during elective aortic arch surgery lengthens cardiopulmonary bypass and aortic cross-clamp times but does not increase postoperative morbidity or mortality.
BACKGROUND: During elective aortic arch replacement, the addition of an aortic root procedure has an unknown effect on morbidity and mortality. The purpose of this study is to determine the effect of adding an aortic root procedure to elective aortic surgery using the ARCH international database. METHODS: The ARCH Database was queried for all elective aortic arch replacements with and without aortic root replacement using moderate hypothermic circulatory arrest and antegrade cerebral perfusion from 2000 to 2015. Propensity score matching analysis was used to balance covariates, and a logistic regression model was created. RESULTS: A total of 1,169 patients were included for analysis, and 320 patients (27.4%) underwent an aortic root procedure. Patients undergoing root procedures were younger (69 versus 61 years), had less coronary artery disease (20% versus 32%), and had a higher incidence of Marfan's syndrome (4.2% versus 10.0%) (p < 0.001 for all). Concomitant coronary artery bypass grafting (26.6% versus 19.7%), total aortic arch replacement (41.6% versus 84.3%), and elephant trunk procedures (46% versus 17.2%) were performed more frequently in the nonroot cohort (p < 0.001 for all). Cardiopulmonary bypass and aortic cross-clamp times were significantly longer in the cohort of patients who underwent root procedures, whereas cerebral perfusion times were longer in the nonroot cohort (p < 0.001 for all). In both the propensity matched and nonmatched analyses, postoperative outcomes were not significantly different between patients who underwent root procedures and patients who did not (p > 0.05 for all outcomes). Multivariable logistic regression analyses showed no difference in mortality rates (odds ratio 0.62, 95% confidence interval: 0.9 to 1.34, p = 0.22) or in rates of permanent stroke (odds ratio 0.89, 95% confidence interval: 0.36 to 2.24, p = 0.81) between the root and nonroot cohorts. CONCLUSIONS: The addition of an aortic root procedure during elective aortic arch surgery lengthens cardiopulmonary bypass and aortic cross-clamp times but does not increase postoperative morbidity or mortality.