Does adding an aortic root replacement or sinus repair during arch repair increase postoperative mortality? Evidence from the Canadian Thoracic Aortic Collaborative

Fadi Hage; Ali Hage; Francois Dagenais; Andreanne Cartier; Maral Ouzounian; Jennifer Chung; Ismail El-Hamamsy; Vincent Chauvette; Mark D Peterson; Kevin Lachapelle; Khalid Ridwan; Munir Boodhwani; Ming Guo; John Bozinovski; Michael C Moon; Abigail White; Michael Yamashita; Carly Lodewyks; Rony Atoui; Darrin Payne; Michael W A Chu; Canadian Thoracic Aortic Collaborative

doi:10.1093/ejcts/ezab125

Does adding an aortic root replacement or sinus repair during arch repair increase postoperative mortality? Evidence from the Canadian Thoracic Aortic Collaborative

Eur J Cardiothorac Surg. 2021 Sep 11;60(3):623-630. doi: 10.1093/ejcts/ezab125.

Authors

Fadi Hage¹, Ali Hage¹, Francois Dagenais², Andreanne Cartier², Maral Ouzounian³, Jennifer Chung³, Ismail El-Hamamsy⁴, Vincent Chauvette⁴, Mark D Peterson³, Kevin Lachapelle⁵, Khalid Ridwan⁵, Munir Boodhwani⁶, Ming Guo⁶, John Bozinovski⁷, Michael C Moon⁸, Abigail White⁸, Michael Yamashita⁹, Carly Lodewyks⁹, Rony Atoui¹⁰, Darrin Payne¹¹, Michael W A Chu¹; Canadian Thoracic Aortic Collaborative

Affiliations

¹ Division of Cardiac Surgery, Department of Surgery, Western University, London, ON, Canada.
² Division of Cardiac Surgery, Department of Surgery, Laval University, Quebec City, QC, Canada.
³ Division of Cardiac Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
⁴ Division of Cardiac Surgery, Department of Surgery, University of Montreal, Montreal, QC, Canada.
⁵ Division of Cardiac Surgery, Department of Surgery, McGill University, Montreal, QC, Canada.
⁶ Division of Cardiac Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada.
⁷ Division of Cardiac Surgery, Department of Surgery, Ohio State University Wexner Medical Center, Columbus, OH, USA.
⁸ Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada.
⁹ Division of Cardiac Surgery, Department of Surgery, University of Manitoba, Winnipeg, MB, Canada.
¹⁰ Division of Cardiac Surgery, Department of Surgery, Health Sciences North, Sudbury, ON, Canada.
¹¹ Division of Cardiac Surgery, Department of Surgery, Queen's University, Kingston, ON, Canada.

PMID: 33769490
DOI: 10.1093/ejcts/ezab125

Abstract

Objectives: The aim of this study was to examine the effect of the addition of an aortic root replacement or sinus repair on mortality and morbidity during aortic arch repair.

Methods: A total of 2472 patients underwent proximal or total aortic arch repair with hypothermic circulatory arrest between 2002 and 2018 at 12 centres. Multivariable logistic regressions (MV) and propensity score (PS) with inverse probability of treatment weighting (IPTW) analyses were performed.

Results: A total of 1099 (44.5%) patients had additional aortic root replacement (n = 934) or sinus repair (n = 165). Those with aortic root interventions were younger (61 ± 13 vs 64 ± 13 years, P < 0.001) and had less females (23% vs 35%, P < 0.001), less dissection (31% vs 36%, P = 0.004), less urgent cases (35% vs 39%, P = 0.047), more connective tissue disease (7% vs 3%, P < 0.001) and less total arch replacements (14% vs 22%, P < 0.001). On adjusted analyses, the addition of aortic root procedure was associated with increased mortality [MV: odds ratio (OR) 1.41, 95% confidence interval (CI) 1.03-1.92; PS-IPTW: risk increased by 3.7%, 95% CI 1.2-6.3%, P = 0.004]. Reoperation for bleeding was also increased with the addition of aortic root intervention (MV: OR 1.48, 95% 1.10-1.99; PS-IPTW: risk increased by 3.2%, 95% CI 0.8-5.6%, P = 0.009). The risks of stroke and dialysis-dependent renal failure were similar. When looking only at non-elective cases, the increased risk of mortality was more pronounced (MV: OR 1.60, 95% CI 1.11-2.32, P = 0.013; PS-IPTW: risk increased by 6.8%, 95 CI 1.7-11.8%, P = 0.008, and a number need to harm of 15 patients to cause 1 additional death).

Conclusions: The addition of aortic root replacement or sinus repair during proximal or total aortic arch repair seems to increase postoperative mortality only in non-elective cases.

Keywords: Aortic arch; Aortic dissection; Aortic root repair.

MeSH terms

Aorta, Thoracic / surgery
Aortic Aneurysm, Thoracic* / surgery
Aortic Valve / surgery
Blood Vessel Prosthesis Implantation* / adverse effects
Canada
Female
Humans
Postoperative Complications / epidemiology
Retrospective Studies
Risk Factors
Treatment Outcome