title: Mid-long-term results after aortic arch repair using a four-branched graft with antegrade selective cerebral perfusion.
abstract: OBJECTIVE
  The purpose of this study is to evaluate mid-long-term results of aortic arch replacement.
  
  
  METHODS
  Between 1992 and 2012, 263 consecutive patients underwent aortic arch repair in our institution. Follow-up rate was 92%, and 243 patients were enrolled in this study. Two hundred twelve patients (87%) underwent total arch replacement using a four-branched graft with antegrade selective cerebral perfusion. Ninety-nine patients (41%) were operated on for acute aortic dissection.
  
  
  RESULTS
  Hospital mortality was 13.2%. The mean follow-up duration was 3.6 ± 3.7 (0-19) years. Late mortality occurred in 38 patients, 4.3 ± 3.2 (0.3-14.1) years after surgery. The survival rates were 85%, 70%, and 50% at one, five, and 10 years. In the acute type A aortic dissection group, survival rate at one and five years was 86% and 79%. In the nonacute type A dissection group, one- and five-year survivals were 85% and 62% (log-rank test: p=0.0027). The causes of late mortality were respiratory failure in five, aortic aneurysm rupture in six, cancer in four, stroke in eight, others in seven, and unknown in eight. Twenty-six patients had another aortic intervention 3.6 ± 6.0 (0.04-19.6) years after arch repair. Seven patients had stroke after discharge 6.5 ± 3.9 (1.9-13.0) years after repair.
  
  
  CONCLUSIONS
  Mid-long-term results after aortic arch repair with antegrade selective cerebral perfusion were satisfactory. Acute type A aortic dissection did not negatively influence the mid-long-term survival.
authors.affiliation: Department of Cardiovascular Surgery, Fukui Cardiovascular Center, Fukui, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Numata
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Tsutsumi
authors.forename: Osamu
authors.initials: O
authors.lastname: Monta
authors.forename: Sachiko
authors.initials: S
authors.lastname: Yamazaki
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Seo
authors.forename: Shohei
authors.initials: S
authors.lastname: Yoshida
authors.forename: Takaaki
authors.initials: T
authors.lastname: Samura
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Ohashi
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000401:mortality* / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery*; D001014:Aortic Aneurysm / Q000401:mortality* / Q000601:surgery*; D001019:Aortic Rupture; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods* / Q000401:mortality*; D002315:Cardiopulmonary Bypass / Q000379:methods; D002423:Cause of Death; D002560:Cerebrovascular Circulation / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010477:Perfusion / Q000379:methods*; D012131:Respiratory Insufficiency; D020521:Stroke; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult