Clinical outcomes of different approaches to aortic arch disease

Abstract

Objective: The aim of this study was to evaluate the midterm clinical outcomes of various approaches, including hybrid procedures, to aortic arch pathologies.

Methods: Of 305 consecutive patients who underwent aortic arch repair between 2005 and 2013, 244 underwent conventional open total aortic arch repair (CTAR) with antegrade cerebral perfusion under circulatory arrest, 35 underwent debranching of the arch with thoracic endovascular aortic repair (DTEVAR), and 26 underwent staged TEVAR after TAR with elephant trunk (TARET). We retrospectively evaluated the outcomes of the three groups.

Results: The DTEVAR group had a greater percentage of patients with preoperative comorbidities. Significant differences were observed in 30-day mortality (DTEVAR, 14.3% [5 of 35] vs TARET TEVAR, 0% [0 of 26] vs CTAR, 5.3% [13 of 244]; P = .045) and stroke (DTEVAR, 28.6% [10 of 35] vs TARET TEVAR, 7.7% [2 of 26] vs CTAR, 8.2% [20 of 244]; P = .001). In overall midterm survival, the DTEVAR group had a lower survival rate (63.9% 3-year survival) compared with the CTAR (90.1% 7-year survival) and the TARET TEVAR (95.5% 2.5-year survival) groups. In elective cases, better midterm results were observed in CTAR and TARET TEVAR groups. An increased number of debranching graft and emergency operations resulted in a much lower follow-up survival rate in the DTEVAR group. Atherosclerotic disease had a great effect on midterm outcomes in the DTEVAR (P = .045) and CTAR groups (P = .002).

Conclusions: The clinical feasibility of DTEVAR for high-risk patients requiring zone 0 landing or emergency surgery is still controversial. Atherosclerotic disease of the aorta has a significant negative effect on midterm outcomes in any surgical approach.