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The Clinical Impact of Concomitant Hemi-Arch Reconstruction at the time of Aortic Root Replacement

Parth M Patel1, Dov Levine2, Andy Dong1

  • 1Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Ga.

JTCVS Open
|April 10, 2026
PubMed

Insights

Concomitant hemi-arch aortic reconstruction during aortic root replacement increases stroke and in-hospital mortality risks. Careful patient selection is crucial for optimal outcomes in complex aortic surgeries.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Aortic Surgery

Background:

  • The clinical significance of combining hemi-arch aortic reconstruction with aortic root replacement remains unclear.
  • This study addresses the impact of concomitant hemi-arch aortic reconstruction during aortic root replacement procedures.

Purpose of the Study:

  • To evaluate the clinical outcomes of aortic root replacement with and without concomitant hemi-arch aortic reconstruction.
  • To compare in-hospital mortality and other adverse events between the two surgical approaches.

Main Methods:

  • A multi-institutional retrospective study involving 1869 patients from 2004-2021.
  • Propensity score matching created 698 pairs comparing aortic root replacement/hemi-arch aortic reconstruction with aortic root replacement/ascending aorta.
  • Primary endpoint was in-hospital mortality.

Main Results:

  • Concomitant hemi-arch aortic reconstruction led to longer bypass and crossclamp times.
  • Higher rates of intra-aortic balloon pump support (6.3% vs 2.4%) and permanent neurologic dysfunction (4.5% vs 2.2%) were observed.
  • In-hospital mortality was significantly higher in the concomitant hemi-arch aortic reconstruction group (5.0% vs 2.6%).

Conclusions:

  • Both aortic root replacement/ascending aorta and concomitant hemi-arch aortic reconstruction yield excellent clinical outcomes.
  • Concomitant hemi-arch aortic reconstruction is associated with increased risks of postoperative stroke and in-hospital mortality.
  • Individualized patient assessment is essential for deciding on concomitant hemi-arch aortic reconstruction during aortic root replacement.
Abstract

Keywords:
aortic aneurysmaortic archaortic root

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