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Surgical Aortic Arch Intervention at the time of Extended Ascending Aortic Replacement is Associated with Increased Mortality
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  • Michael Bowdish,
  • Daniel Logsdon,
  • Ramsey Elsayed,
  • Wendy Mack,
  • Brittany Abt,
  • Fernando Fleischman,
  • Kayvan Kazerouni,
  • Vaughn Starnes,
  • Robbin Cohen
Michael Bowdish
University of Southern California
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Daniel Logsdon
Keck School of Medicine, University of Southern California
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Ramsey Elsayed
University of Southern California
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Wendy Mack
University of Southern California
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Brittany Abt
University of Southern California
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Fernando Fleischman
Keck School of Medicine, University of Southern California
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Kayvan Kazerouni
Keck School of Medicine, University of Southern California
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Vaughn Starnes
Keck School of Medicine, University of Southern California
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Robbin Cohen
University of Southern California
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Abstract

Objective: To compare outcomes of hemiarch versus total arch repair during extended ascending aortic replacement. Methods: Between 2004 and 2017, 261 patients underwent hemiarch (n=149, 57%) or total arch repair (aortic debranching or Carrell patch technique, n=112, 43%) in the setting of extended replacement of the ascending aorta. Median follow-up was 17.2 (IQR 4.2–39.1) months. Multivariable models considering preoperative and intraoperative factors associated with mortality and aortic reintervention were constructed. Results: Survival was 89.0, 81.3, and 73.5% vs. 76.4, 69.5, and 61.7% at 1, 3, and 5 years in the hemiarch versus total arch groups, respectively (log-rank p=0.010). After adjustment for preoperative and intraoperative factors, the presence of a total arch repair (adjusted HR 2.53, 95% CI 1.39 – 4.62, p=0.003), and increasing age (adjusted HR per 10 years of age, 1.76, 95% CI 1.37 – 2.28, p<0.001) were associated with increased mortality. The cumulative incidence of aortic reintervention with death as a competing outcome was 2.6, 2.6, and 4.4% and 5.0, 10.3, and 11.9% in the hemiarch and total arch groups, respectively. After adjustment, the presence of a total arch repair was significantly associated with need for aortic reintervention (SHR 3.21, 95% CI 1.01 – 10.2, p=0.047). Conclusions: Overall survival after aortic arch repair in the setting of extended ascending aortic replacement is excellent, however, total arch repair and increasing age are associated with higher mortality and reintervention rates. A conservative approach to aortic arch repair can be prudent, especially in those of advanced age.

Peer review status:IN REVISION

14 Jul 2021Submitted to Journal of Cardiac Surgery
15 Jul 2021Assigned to Editor
15 Jul 2021Submission Checks Completed
15 Jul 2021Reviewer(s) Assigned
10 Aug 2021Review(s) Completed, Editorial Evaluation Pending
12 Aug 2021Editorial Decision: Revise Major