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 after a prior aortic operation from January 1993 through February 2025. Multivariable Cox regression analysis was used to identify predictors of late mortality.

The annual reoperative TAR (n = 219) volume increased more than 4-fold during the study period (P < .001). Early mortality was 5.9% (n = 13) and improved significantly over time (1993-2010: 14.6% vs 2011-2025: 3.9%; P = .009). Postoperative stroke occurred in 12 (5.5%) patients, declining from 12.2% in 1993-2010 to 4.0% in 2011-2025 period (P = .037). The median interval from prior surgery was 6.0 years (interquartile range, 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 (hazard ratio [HR], 0.94; 95% CI, 0.91-0.98), age (HR, 1.04; 95% CI, 1.01-1.06), moderate or 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.