Contemporary results of hemiarch replacement

Abstract

Objectives: Our goal was to report on early and midterm outcomes of hemiarch replacement performed in a high-volume centre.

Methods: We extrapolated hemiarch replacements from our institutional aortic database. We also analysed the impact of aortic disease (dissection vs aneurysm) on the outcomes of de novo hemiarch replacement.

Results: A total of 756 patients underwent hemiarch replacement between 1997 and 2016. After elimination of cases involving the aortic root/valve and redo cases, we identified 426 cases of de novo -isolated hemiarch replacement (369 aneurysms and 57 dissections). Overall operative mortality was 3.1% (13 of 426). The most frequent complications were respiratory failure requiring tracheostomy (11 of 426, 2.6%) and renal failure requiring dialysis (7 of 426, 1.6%). On regression analysis, previous myocardial infarction was the only independent predictor of major adverse events (odds ratio 3.14; 95% confidence interval 1.36-7.22; P = 0.007). Operative mortality was 5.3% (3 of 57) for dissections and 2.7% (10 of 369) for aneurysms ( P = 0.29). The postoperative need for tracheostomy and for new dialysis was more frequent in the dissection group (4 of 57 vs 7 of 369; P = 0.02 and 3 of 57 vs 4 of 369; P = 0.02, respectively). At 5 years, the overall survival rate was 72.5% (95% confidence interval 66.4-78.6%), and there was no difference in survival and risk of reoperation between the 2 groups ( P = 0.97).

Conclusions: In high-volume centres, aortic hemiarch replacement can be performed with excellent results. The aortic disease only partially affects the early and midterm outcomes.

Keywords: Aortic aneurysm; Aortic dissection; Aortic surgery; Arch replacement; Hemiarch.