Branch-first aortic arch replacement strategy decreases perioperative mortality.

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Vascular Surgery

Background:

• Limited evidence exists on the superiority of the branch-first technique for total arch replacement (TAR) with antegrade cerebral perfusion (ACP).
• Conventional TAR techniques have associated morbidity and mortality risks that necessitate evaluation of alternative approaches.

Purpose of the Study:

• To compare the perioperative outcomes of traditional TAR versus branch-first TAR.
• To assess the impact of the branch-first technique on 30-day mortality and adverse events.

Main Methods:

• Retrospective review of 144 patients undergoing TAR between January 2017 and December 2021.
• Patients were divided into traditional TAR and branch-first TAR groups.
• Comparison of primary endpoints (30-day mortality, adverse events) using statistical tests and logistic regression.

Main Results:

• The branch-first TAR cohort (76 patients) exhibited significantly lower 30-day mortality (4% vs. 19%, P=0.004) compared to the traditional TAR cohort (68 patients).
• Shorter median ACP times were observed in the branch-first TAR group (P=0.001).
• After multivariable adjustment, branch-first TAR was associated with a 93% reduction in the odds of 30-day mortality (OR, 0.07; P=0.007).

Conclusions:

• Branch-first total arch replacement is associated with significantly reduced 30-day mortality compared to traditional total arch replacement.
• The branch-first technique represents a potentially safer and more effective approach for aortic arch surgery.