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Over Two Decades of Experience in Aortic Arch Reoperations: Long-Term Outcomes and Mortality Risk Factors
Nikoleta Bozini1, Nicole Piber1, Keti Vitanova1
1Department of Cardiovascular Surgery, Institute Insure, German Heart Center Munich, School of Medicine & Health, Technical University of Munich, Lazarettstrasse 36, 80636 Munich, Germany.
Journal of Clinical Medicine
|June 26, 2025
Summary
Aortic arch reoperations are feasible with acceptable outcomes, but perioperative factors like salvage operations, bleeding, and prolonged ventilation significantly impact early mortality. Older age, especially over 57.5 years, increases mortality risk.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Background:
- Aortic arch surgery techniques have advanced, improving safety and long-term results.
- Increasing patient longevity necessitates more frequent aortic arch reoperations.
- This study evaluates the long-term safety and mortality risk factors of aortic arch reoperations.
Purpose of the Study:
- To analyze the safety and long-term outcomes of aortic arch reoperations.
- To identify preoperative and perioperative risk factors associated with mortality after aortic arch reoperation.
Main Methods:
- Retrospective analysis of 108 patients undergoing aortic arch reoperation between 1999 and 2023.
- Exclusion criteria included age under 18 and prior transcatheter aortic valve implantation.
- Primary outcome was mortality; secondary outcomes included re-reoperation, bleeding, dissection, endocarditis, readmission, coronary intervention, neurovascular complications, pacemaker implantation, and mechanical circulatory support.
Main Results:
- Preoperative risk factors for adverse outcomes included older age and a history of coronary artery disease.
- Perioperative factors associated with higher mortality were salvage reoperation, longer operation time, cardiopulmonary bypass duration, ventilation time, bleeding complications, and need for temporary mechanical circulatory support.
- Overall survival rates were 82% at 1 year, 73% at 5 years, and 56% at 10 years. Multivariate analysis identified age (>57.5 years), salvage operation, prolonged ventilation, and bleeding complications as independent predictors of mortality.
Conclusions:
- Aortic arch reoperations can achieve acceptable long-term results.
- Perioperative factors, specifically the need for salvage operations, bleeding complications, and prolonged ventilation, are critical determinants of early mortality.
- Advanced age, particularly over 57.5 years, is a significant independent risk factor for increased mortality following aortic arch reoperation.
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