Early and long-term outcome of total arch replacement using selective cerebral perfusion

The aim of this study was to analyze mortality and morbidity of patients undergoing total arch replacement.

We analyzed data from 122 patients who underwent total arch replacement. Total arch replacement was performed using selective cerebral perfusion, with an open distal anastomosis using a trifurcated coated graft. Univariate and multivariate analysis were performed concerning postoperative neurologic dysfunction and early mortality. Long-term mortality was estimated by the Kaplan-Meier method.

Permanent and temporary neurologic dysfunction were 4.1% (5 cases) and 5.7% (7 cases), respectively. Hospital mortality was 8.2% (10 cases). There was no significant difference in hospital mortality or neurologic dysfunction between the two groups divided by age less than or greater than 70 years old, emergency versus elective surgery, and dissection versus true aneurysm. After multivariate analysis, independent predictors for hospital mortality were found to be infection, operation time longer than 10 hours, and EuroSCORE greater than 15; whereas those for neurologic dysfunction were operation time longer than 10 hours and ischemic heart disease. Overall long-term survival was 80.4% at 5 years and 58.9% at 10 years.

The early and long-term outcomes of total arch replacement using selective cerebral perfusion and appropriate establishment of cardiopulmonary bypass were satisfactory.