title: Evolution in the techniques and outcomes of aortic arch surgery: a 22 year single centre experience.
abstract: BACKGROUND
  Aortic arch replacement is a complicated and high risk procedure. There have been many advances over recent years. We review the changes in our unit's techniques and outcomes over the past 22 years.
  
  
  METHODS
  Data were collated from databases and medical records for all patients who underwent aortic arch replacement surgery from January 1989 to December 2010. The patients were divided into two groups - Group A (1989-2005) and Group B (2006-2010). Data were analysed to compare early and late series patients' outcomes. Logistic regression was used to identify variables that predicted mortality.
  
  
  RESULTS
  Seventy-five eligible patients (56 males; mean age: 57.5 years; Group A: 40, Group B 35) were identified. There were great changes in the technique and the methods of cerebral protection. The overall mortality rate was 30.7% - Group A: 50% and Group B: 8.6% (p<0.001). Overall permanent neurological dysfunction was 23.7% - Group A: 40% and Group B: 11.8% (p=0.012). Cardiovascular disease and circulatory arrest time were significant predictors of mortality.
  
  
  CONCLUSIONS
  Increased experience and volume and advances in techniques over 22 years have resulted in major improvements in outcomes for patients having aortic arch replacement, allowing the procedure to be performed with greatly improved outcomes.
authors.affiliation: Faculty of Medicine, The University of Sydney, Sydney, Australia.
authors.forename: Reece A
authors.initials: RA
authors.lastname: Davies
authors.forename: Deborah
authors.initials: D
authors.lastname: Black
authors.forename: Richmond W
authors.initials: RW
authors.lastname: Jeremy
authors.forename: Paul G
authors.initials: PG
authors.lastname: Bannon
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Bayfield
authors.forename: P Nicholas
authors.initials: PN
authors.lastname: Hendel
authors.forename: Clifford F
authors.initials: CF
authors.lastname: Hughes
authors.forename: Michael K
authors.initials: MK
authors.lastname: Wilson
authors.forename: Michael P
authors.initials: MP
authors.lastname: Vallely
mesh_terms: D000328:Adult; D000368:Aged; D017130:Angioplasty / Q000266:history; D001013:Aorta, Thoracic / Q000378:metabolism* / Q000601:surgery*; D001014:Aortic Aneurysm / Q000401:mortality* / Q000601:surgery*; D005260:Female; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies