Outcomes of Primary vs Reoperative Aortic Arch Surgery

Reoperative surgery to replace the aortic arch is perceived as technically complex and high risk. However, this procedure is often necessary to treat primary disease or to create an endovascular landing zone for distal aortic disease. We investigated our institutional outcomes in patients who underwent reoperative open arch (RA) surgery compared with patients who underwent primary arch (PA) replacement.

All adult patients who underwent open arch surgery from January 2019 to May 2023 at a single academic institution were queried for inclusion. The final cohort was 142 patients; 59 patients underwent RA surgery, and 83 patients received an open arch replacement as their index cardiac operation (PA).

The average age of the entire cohort was 61.5 years. Preoperative demographics were largely similar between the groups. Illicit drug use was higher in the PA group (12.1% [n = 10] vs 0%; P < .05). The distribution of disease was different between the groups; the RA group had a high preponderance of prior type A repair (66.1% [n = 39]), whereas the PA group was largely a combination of acute type A dissection (41.0% [n = 34]) and elective aneurysm repair (28.9% [n = 24]; P < .05). Perioperative outcomes were similar between the groups, including rate of stroke, dialysis initiation, and mortality. Overall stroke rate for the entire cohort was 9.2% (n = 13). Overall, in-hospital mortality was 7.0% (n = 10); 3-year survival was similar between the groups (P = .969).

In an experienced aortic center, RA replacement demonstrated similar short-term and 3-year outcomes compared with PA replacement.