Impact of reimplantation technique of supra-aortic branches in total arch replacement on stroke rate and survival

Results from the ARCH registry

Florian S. Schoenhoff*, David H. Tian, Martin Misfeld, Konstantinos G. Perreas, David Spielvogel, Friedrich W. Mohr, Friedhelm Beyersdorf, Tristan D. Yan, Thierry P. Carrel

*Corresponding author for this work

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objectives: Our objective was to evaluate the impact of reimplantation techniques of the supra-aortic branches in total arch replacement on the rates of permanent neurological deficit (PND) and survival. Methods: We identified patients enrolled in the ARCH registry who underwent total arch replacement between 2000 and 2015 with either en bloc or separate reimplantation of the supra-aortic branches. Results: A total of 3345 patients were included in the present analysis. From this cohort, 686 patients underwent en bloc and 2659 patients had separate reimplantation of the supra-aortic branches. Propensity score analysis identified 461 matched patient pairs. In the matched cohort, there were no differences regarding the mortality rate (15.6% vs 15.7%, P = 0.710) or PND (9.2% vs 12.1%, P = 0.231). Although separate reimplantation of the supra-aortic branches was not associated with an increased mortality rate on multivariable logistic regression, it increased the risk of PND [odds ratio (OR) 1.56, 95% confidence interval (CI) 1.06–2.29; P = 0.023]. Propensity-adjusted regression confirmed these findings and found a similar risk for PND with separate reimplantation of the supra-aortic branches (OR 1.50, 95% CI 1.01–2.23; P = 0.047), although this significance was not found with conditional logistic regression (P = 0.20). No significant differences between survival were seen between the 2 matched cohorts (stratified log rank P = 0.35). Conclusions: Separate reimplantation of the supra-aortic branches in total arch replacement is a significant predictor of stroke in the overall group, although comparable stroke rates were observed in the matched cohort. The current trend towards separate reimplantation of supra-aortic branches may expose certain subgroups of patients to an increased risk of stroke, e.g. those with a high atherosclerotic burden.

Original languageEnglish
Pages (from-to)1045-1051
Number of pages7
JournalEuropean Journal of Cardio-thoracic Surgery
Volume54
Issue number6
DOIs
Publication statusPublished - Dec 2018

Keywords

  • Aortic arch
  • Aortic arch aneurysm
  • Aortic arch replacement
  • Aortic dissection
  • SURGERY
  • ELEPHANT TRUNK
  • REPAIR
  • TOTAL AORTIC-ARCH
  • DISSECTION
  • STRATEGY
  • LONG-TERM OUTCOMES
  • EXPERIENCE

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