title: Predictors of early and late outcome after total arch replacement for atherosclerotic aortic arch aneurysm.
abstract: OBJECTIVE
  This study aimed to identify predictors of early and late outcome after total arch replacement (TAR) for atherosclerotic aortic arch aneurysm.
  
  
  METHODS
  TAR with separate arch vessel grafting and selective cerebral perfusion was performed in 130 patients. The median age at operation was 72.9 ± 6.1 years (57-86 years). Emergency operation was performed in 9 patients (6.9 %) and the frozen elephant trunk technique was used in 51 patients (39.2 %).
  
  
  RESULTS
  The in-hospital mortality rate was 3.8 %. Chronic renal failure (CRF) was identified as an independent predictor of in-hospital mortality (p = 0.0001). Permanent neurological dysfunction occurred in nine patients (6.9 %). Clot or atheroma in the aneurysm (p = 0.01) and the duration of selective cerebral perfusion (p = 0.011) were identified as independent predictors of permanent neurological dysfunction. Long-term survival rates were 82.0 % at 3 years, 70.0 % at 5 years, and 52.4 % at 8 years postoperatively. CRF (p = 0.0190), age (p = 0.0147), and permanent neurological dysfunction (p = 0.0048) were identified as independent predictors of long-term mortality.
  
  
  CONCLUSIONS
  Prevention of permanent neurological dysfunction is crucial for long-term survival after TAR. Older patients with renal dysfunction may have reduced long-term survival after TAR.
authors.affiliation: Department of Surgery 2, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan, shiori@med.miyazaki-u.ac.jp.
authors.forename: Kunihide
authors.initials: K
authors.lastname: Nakamura
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nagahama
authors.forename: Eisaku
authors.initials: E
authors.lastname: Nakamura
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Yano
authors.forename: Masakazu
authors.initials: M
authors.lastname: Matsuyama
authors.forename: Masanori
authors.initials: M
authors.lastname: Nishimura
authors.forename: Atsuko
authors.initials: A
authors.lastname: Yokota
authors.forename: Hirohito
authors.initials: H
authors.lastname: Ishii
mesh_terms: D000368:Aged; D001013:Aorta, Thoracic / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D010264:Paraplegia / Q000209:etiology; D011183:Postoperative Complications; D011379:Prognosis; D015996:Survival Rate