Aortic arch operation: current treatment and results

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Vascular Surgery

Background:

• Transverse aortic arch disease presents significant surgical challenges.
• Aortic dissections and aneurysms require complex reconstructive procedures.
• Understanding outcomes for different aortic pathologies is crucial for surgical planning.

Purpose of the Study:

• To evaluate the surgical outcomes for patients with transverse aortic arch disease.
• To compare results across different aortic pathologies: acute dissection, chronic dissection, and aneurysms.
• To assess the impact of surgical techniques and adjuncts on mortality.

Main Methods:

• Retrospective analysis of 227 patients undergoing transverse aortic arch surgery between 1987 and 1993.
• Categorization into acute dissection (Group A), chronic dissection (Group B), and aneurysms (Group C).
• Procedures included graft replacement, elephant trunk, and patch graft repairs, with varying aortic valve interventions and use of hypothermic circulatory arrest and retrograde cerebral perfusion.

Main Results:

• In-hospital mortality was 6.17% (14/227).
• Long-term mortality after complete follow-up was 9.26% (20/216).
• Circulatory arrest times varied, with retrograde cerebral perfusion used in 48.9% of patients.

Conclusions:

• Surgical treatment of transverse aortic arch disease has acceptable in-hospital and long-term mortality rates.
• The study highlights the feasibility of complex aortic arch reconstructions using hypothermic circulatory arrest.
• Outcomes data provide valuable insights for managing patients with diverse aortic arch pathologies.