Outcomes of Total Arch Replacement After Prior Aortic Surgery

To evaluate outcomes of total arch replacement (TAR) performed after prior aortic surgery.

We retrospectively reviewed patients undergoing TAR following a prior aortic operation from 1/1993 through 2/2025. Multivariable Cox regression analysis was used to identify predictors of late-mortality.

The annual reoperative TAR (n=219) volume increased more than fourfold during the study period (p<0.001). Early mortality was 5.9% (n=13) and improved significantly over time (1993-2010: 14.6% versus 2011-2025: 3.9%,p=0.009). Postoperative stroke occurred in 12 (5.5%) patients, declining from 12.2% in 1993-2010 to 4.0% in 2011-2025 period (p=0.037). The median interval from prior surgery was 6.0 years (Interquartile range[IQR] 2.5-10.4). Overall survival at 5 and 10 years was 74.7% (95%CI 68.8-81.3%) and 61.3% (95%CI 53.2-70.5%), respectively. Predictors of late mortality included surgery year (HR 0.94, 95%CI 0.91-0.98), age (HR 1.04, 95%CI 1.01-1.06), moderate/severe obstructive pulmonary disease (HR 2.42, 95%CI 1.00-5.83) renal failure (HR 4.28, 95%CI 1.36-13.45), emergency operations (HR 6.87, 95%CI 2.22-21.24) and circulatory arrest time (HR 1.01, 95%CI 1.00-1.02). Extent of the prior operation and concomitant root surgery did not influence outcomes.

TAR after prior aortic surgery has become more common over time, with improvements in early mortality and stroke rates.