title: Total surgical aortic arch replacement as a safe strategy to treat complex multisegmental proximal thoracic aortic pathology.
abstract: OBJECTIVE
  To analyse the results after elective open total aortic arch replacement.
  
  
  METHODS
  We analysed 39 patients (median age 63 years, median logistic EuroSCORE 18.4) who underwent elective open total arch replacement between 2005 and 2012.
  
  
  RESULTS
  In-hospital mortality was 5.1% (n = 2) and perioperative neurological injury was 12.8% (n = 5). The indication for surgery was degenerative aneurysmal disease in 59% (n = 23) and late aneurysmal formation following previous surgery of type A aortic dissection in 35.9% (n = 14); 5.1% (n = 2) were due to anastomotical aneurysms after prior ascending repair. Fifty-nine percent (n = 23) of the patients had already undergone previous proximal thoracic aortic surgery. In 30.8% (n = 12) of them, a conventional elephant trunk was added to total arch replacement, in 28.2% (n = 11), root replacement was additionally performed. Median hypothermic circulatory arrest time was 42 min (21-54 min). Selective antegrade cerebral perfusion was used in 95% (n = 37) of patients. Median follow-up was 11 months [interquartile range (IQR) 1-20 months]. There was no late death and no need for reoperation during this period.
  
  
  CONCLUSIONS
  Open total aortic arch replacement shows very satisfying results. The number of patients undergoing total arch replacement as a redo procedure and as a part of a complex multisegmental aortic pathology is high. Future strategies will have to emphasize neurological protection in extensive simultaneous replacement of the aortic arch and adjacent segments.
authors.affiliation: Department of Cardiovascular Surgery, University Hospital Berne, Berne, Switzerland. martin.czerny@insel.ch
authors.forename: Martin
authors.initials: M
authors.lastname: Czerny
authors.forename: Tobias
authors.initials: T
authors.lastname: König
authors.forename: David
authors.initials: D
authors.lastname: Reineke
authors.forename: Gottfried H
authors.initials: GH
authors.lastname: Sodeck
authors.forename: Maximilian
authors.initials: M
authors.lastname: Rieger
authors.forename: Florian
authors.initials: F
authors.lastname: Schoenhoff
authors.forename: Reto
authors.initials: R
authors.lastname: Basciani
authors.forename: Hansjörg
authors.initials: H
authors.lastname: Jenni
authors.forename: Jürg
authors.initials: J
authors.lastname: Schmidli
authors.forename: Thierry P
authors.initials: TP
authors.lastname: Carrel
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D017558:Elective Surgical Procedures; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Aneurysm; Aortic arch surgery; Dissection; Multisegmental thoracic aortic pathology