AI Article Synopsis

  • This study analyzes the impacts of total arch replacement (TAR) on postoperative recovery and long-term survival for 75 patients, focusing on techniques like deep to moderate hypothermic circulatory arrest (HCA) and antegrade cerebral perfusion (ACP).
  • The patient demographics showed a median age of 66 years, with various underlying conditions like dissections and atherosclerosis contributing to their aneurysms, and an in-hospital mortality rate of 5%.
  • Long-term survival rates indicated that 89% of patients survived one year post-surgery, 78% at five years, and 73% at ten years; the study highlights the technique's safety but suggests further research is needed to determine the effectiveness of early

Article Abstract

This study examines postoperative morbidity and mortality and long-term survival after total arch replacement (TAR) using deep to moderate hypothermic circulatory arrest (HCA), antegrade cerebral perfusion (ACP), and the Y-graft. Seventy-five patients underwent TAR with the Y graft. Deep to moderate HCA was initiated at 18-22°C. ACP was either initiated immediately (early ACP) or after the distal anastomosis was performed (late ACP). The arch vessels were then serially anastomosed to the individual limbs of the Y-graft. The median age was 66 years (range = 32-82). Etiology of aneurysmal dilatation included 20 (27%) patients with medial degenerations, 25 (33%) with chronic dissections, 14 (19%) with acute dissections, 9 (12%) with atherosclerosis and 2 (3%) with Marfan syndrome. In-hospital mortality was 5%. Neurologic complications occurred in 8 (11%) patients; 2 (3%) had strokes and 6 (8%) had transient neurologic deficits. Patients undergoing TAR with moderate hypothermia had a significantly higher incidence of new-onset renal insufficiency (3 [23%] vs [0%], P < 0.001) and TND (3 (23%) vs 3 (5%), P = 0.028) than the profound and deep hypothermia cohort. Excluding the 1 patient who died intraoperatively, 89% (95%CI: 79-94%) were alive at 1 year, 78% at 5 years (95%CI: 66-86%), and 73% at 10 years (95%CI: 59-82%). The combination of deep to moderate HCA, ACP, and the Y-graft is a safe and reproducible technique. Further inquiry is needed to assess if early ACP provides superior clinical outcomes.

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http://dx.doi.org/10.1053/j.semtcvs.2020.03.001DOI Listing

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