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Evolving Surgical Techniques and Improving Outcomes for Aortic Arch Surgery in Canada
Marina Ibrahim1, Louis-Mathieu Stevens2, Maral Ouzounian1
1Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
CJC Open
|October 29, 2021
Summary
Surgical outcomes for elective aortic arch repair have improved in Canada due to evolving techniques like moderate hypothermia and antegrade cerebral perfusion. Further research is needed to address stroke rates and emergency case outcomes.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Background:
- Aortic arch surgery is complex, with evolving techniques and varying outcomes.
- Hypothermic circulatory arrest is a common method for aortic arch repair.
Purpose of the Study:
- To analyze trends in surgical techniques and patient outcomes for aortic arch repair.
- To evaluate the impact of evolving methods on in-hospital morbidity and mortality.
Main Methods:
- A retrospective analysis of 2435 consecutive patients undergoing aortic arch repair with hypothermic circulatory arrest.
- Data collected from 12 Canadian institutions between 2008 and 2018.
- Examination of patient characteristics, surgical techniques, and in-hospital outcomes.
Main Results:
- Elective aortic arch surgery demonstrated improved outcomes, with decreased in-hospital mortality and major morbidity/mortality.
- Surgical techniques shifted towards valve-sparing root replacements and increased use of elephant trunk and frozen elephant trunk repairs.
- Increased use of moderate hypothermia and antegrade cerebral perfusion was observed, while stroke rates remained constant.
Conclusions:
- Elective aortic arch surgery outcomes have improved over a decade in Canada.
- Advancements in moderate hypothermia and antegrade cerebral perfusion contribute to better outcomes.
- Further research is required to reduce stroke rates and improve outcomes in emergency aortic arch surgery.