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).