In-hospital and Long-term Outcomes of Aortic Arch Surgery

Abstract

Background: Treatment of patients with acute or chronic aortic arch disease has been historically associated with poor outcomes. Objective: The aim of this study was to analyze in-hospital and long-term outcomes of aortic arch replacement comparing emergency and elective procedures. Methods: We conducted a retrospective cohort study in patients undergoing aortic arch surgery in a high complexity center between January 2010 and December 2016, with one-year follow-up. Results: A total of 65 patients were included; 65% were men and median age was 71 years. Among postoperative complications, prolonged mechanical ventilation was more common in the emergency than in the elective surgery group (52% vs. 19%, p=0.006). The incidence of reoperation due to bleeding, mediastinitis, stroke, and renal failure requiring dialysis in the postoperative period was not significantly different between both groups. In-hospital mortality was 15% and observed mortality 24%, without significant differences according to emergency or elective procedure. Conclusions: In this cohort of patients undergoing aortic arch surgery, in-hospital mortality and 1-year mortality was similar in patients undergoing emergency or elective surgeries. The risk of mortality during the first year was 4 times greater in patients >75 years than in younger ones. The incidence of mortality and postoperative stroke was similar to that reported by recent registries. The incidence of reoperations due to bleeding was remarkably low. The rate of complications (reoperations due to bleeding, stroke, acute renal failure or infection) was not statistically different between both groups, probably because of lack of power of the sample