Results
Eighty-six elective aortic arch surgeries were performed during the analyzed period, including 25 patients (29%) in group A and 61 patients in group B (71%). The indication for surgery was aortic arch aneurysm in 53 patients (61.5%), chronic aortic dissection in 30 patients (35%) and saccular aneurysm in 3 patients (3.5%). Patients’ median age (IQR) was 64 years (54-69), 50 patients (58%) were male. Median (IQR) EuroScore II was 4.98 (3.01-8.89). Detailed baseline characteristics of the patients is presented in Table 1.
The analysis of baseline characteristics in both study groups revealed that patients in group B were significantly younger than those in group A, 62 years (53-68) vs 67 years (60-70) (P =0.046) and were in higher New York Heart Association (NYHA) classes(P =0.049). Group B included more patients with co-existing descending aorta aneurysm, 27 patients (44%) vs 6 patients (24%)(P =0.09). Patients in group A had significantly higher serum creatinine concentration (IQR) of 1.02 mg/dl (0.79-1.37) vs 0.82 mg/dl (0.7-1.0) (P =0.004) , and lower left ventricular ejection fraction (LVEF) (IQR) of 50% (45-60) vs 55% (50-60)(P =0.06).
In the entire study population the hemiarch procedure was performed in 38 patients (44%) and total aortic arch replacement in 48 patients (56%). Detailed surgical data is presented in Table 2.
The hemiarch procedure was more frequently performed in group A (17 patients, 68%) in comparison to group B (21 patients, 34%)(P =0.008) (Fig. 3). More procedures involving descending aorta were performed in group B (27 patients, 44%) than in group A (6 patients, 24%) (P =0.09), and 4 patients (6.6%) in group B had an aortic valve sparing procedure in comparison to no patient in group A (P =0.32). Deep hypothermia with circulatory arrest was more frequently used for brain protection in group A: 6 patients (24%) vs 2 patients (3.3%) (P =0.007) , whereas there were more selective brain perfusions in group B: 59 patients (96.7%) vs 21 patients (84%) (P =0.057).
Significantly longer CPB time was recorded in group B (IQR): 200 minutes (148-254) vs 163 minutes (125-208) (P =0.03) .
There were no differences between study groups regarding postoperative data such as bleeding volume, mechanical ventilation time and days of ICU and hospital stay.
The analysis of postoperative morbidity (Table 2) revealed significantly higher rate of stroke in group A: 6 patients (20%) vs 5 patients (8.2%) (P =0.002) . There were no differences between groups with regard to the rate of chest re-exploration due to bleeding, acute kidney failure, pneumonia and surgical wound infection.
This analysis includes complete data on mortality from all patients. The median (IQR)
time of follow‑up was 32.5 (13.9–56.6) months. Of note, there was higher early mortality (30 days post-surgery) in patients from group A: 5 patients (20%) vs 5 patients (8.2%) (P =0.15).
Five-year survival estimated from Kaplan-Meier curve was 60±9.8% for group A, and 81±6.2% for group B (Fig. 4). The comparison of both study groups showed a significant difference in survival (log-rank test,P =0.03) favoring those operated during the second 5-year period (group B).