title: Clinical outcomes of different approaches to aortic arch disease.
abstract: OBJECTIVE
  The aim of this study was to evaluate the midterm clinical outcomes of various approaches, including hybrid procedures, to aortic arch pathologies.
  
  
  METHODS
  Of 305 consecutive patients who underwent aortic arch repair between 2005 and 2013, 244 underwent conventional open total aortic arch repair (CTAR) with antegrade cerebral perfusion under circulatory arrest, 35 underwent debranching of the arch with thoracic endovascular aortic repair (DTEVAR), and 26 underwent staged TEVAR after TAR with elephant trunk (TARET). We retrospectively evaluated the outcomes of the three groups.
  
  
  RESULTS
  The DTEVAR group had a greater percentage of patients with preoperative comorbidities. Significant differences were observed in 30-day mortality (DTEVAR, 14.3% [5 of 35] vs TARET TEVAR, 0% [0 of 26] vs CTAR, 5.3% [13 of 244]; P = .045) and stroke (DTEVAR, 28.6% [10 of 35] vs TARET TEVAR, 7.7% [2 of 26] vs CTAR, 8.2% [20 of 244]; P = .001). In overall midterm survival, the DTEVAR group had a lower survival rate (63.9% 3-year survival) compared with the CTAR (90.1% 7-year survival) and the TARET TEVAR (95.5% 2.5-year survival) groups. In elective cases, better midterm results were observed in CTAR and TARET TEVAR groups. An increased number of debranching graft and emergency operations resulted in a much lower follow-up survival rate in the DTEVAR group. Atherosclerotic disease had a great effect on midterm outcomes in the DTEVAR (P = .045) and CTAR groups (P = .002).
  
  
  CONCLUSIONS
  The clinical feasibility of DTEVAR for high-risk patients requiring zone 0 landing or emergency surgery is still controversial. Atherosclerotic disease of the aorta has a significant negative effect on midterm outcomes in any surgical approach.
authors.affiliation: Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan. Electronic address: bassbord1028@yahoo.co.jp.
authors.forename: Arudo
authors.initials: A
authors.lastname: Hiraoka
authors.affiliation: Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan.
authors.forename: Genta
authors.initials: G
authors.lastname: Chikazawa
authors.affiliation: Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Tamura
authors.affiliation: Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan.
authors.forename: Toshinori
authors.initials: T
authors.lastname: Totsugawa
authors.affiliation: Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan.
authors.forename: Taichi
authors.initials: T
authors.lastname: Sakaguchi
authors.affiliation: Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan.
authors.forename: Hidenori
authors.initials: H
authors.lastname: Yoshitaka
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001018:Aortic Diseases / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods / Q000401:mortality; D002560:Cerebrovascular Circulation; D017558:Elective Surgical Procedures; D004630:Emergencies; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods / Q000401:mortality; D005240:Feasibility Studies; D005260:Female; D006324:Heart Arrest, Induced; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D010477:Perfusion; D011474:Prosthesis Design; D012039:Regional Blood Flow; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome