Open aortic arch replacement in high-risk patients: the gold standard

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Vascular Surgery

Background:

• Open total aortic arch replacement (TAR) carries perceived high perioperative risks in elderly and comorbid patients.
• Hybrid techniques have emerged as an alternative for high-risk patients requiring TAR.
• This study evaluates the outcomes of traditional open TAR in a selected high-risk cohort.

Purpose of the Study:

• To assess the perioperative and long-term outcomes of open total aortic arch replacement (TAR) in high-risk patients.
• To compare the safety and efficacy of open TAR versus alternative approaches in this challenging patient group.
• To determine the feasibility and success rate of open TAR in patients with significant comorbidities.

Main Methods:

• Retrospective analysis of patients undergoing open TAR between 2000 and 2013.
• Selection criteria included logistic EuroSCORE between 20-60, excluding aortic root or mitral/tricuspid valve interventions.
• Data collected included demographics, comorbidities, concomitant procedures, and in-hospital/long-term outcomes.

Main Results:

• Fifty-eight high-risk patients (median logistic EuroSCORE 27.4, median age 76) underwent open TAR.
• In-hospital mortality was 6.9%, with permanent stroke and spinal cord injury rates of 1.7% and 0%, respectively.
• One, 5, and 10-year survival estimates were 82.7%, 70.0%, and 37.8%, with no deaths or strokes in the elective subgroup.

Conclusions:

• Open total aortic arch replacement (TAR) is a safe and effective procedure with low mortality and morbidity in high-risk patients.
• Excellent long-term survival rates support the continued use of open TAR for suitable high-risk individuals.
• Total endovascular repair may be considered for patients unsuitable for open surgical approaches.