title: Long-term outcomes after aortic arch surgery: results of a study involving 623 patients.
abstract: OBJECTIVE
  To assess early and long-term outcomes in a large cohort of patients undergoing open aortic arch surgery.
  
  
  METHODS
  From 1996 to 2012, 623 consecutive patients (mean age: 62.8 years) underwent aortic arch interventions in our institution. Of these, 208 (33.4%) presented with an acute aortic syndrome (AAS) and 415 (66.6%) with a chronic aortic pathology (CAP). During the study period, our surgical strategy involved extensive resections of the diseased aortic tissue at elective interventions, and a tear-oriented aortic replacement in patients with acute dissection. More extensive interventions were often performed in younger patients, and in those with connective tissue diseases and bicuspid aortic valves. A total arch replacement was frequently performed (53.3%). Antegrade selective cerebral perfusion was used in all cases.
  
  
  RESULTS
  Overall in-hospital mortality was 23.1% in patients with AAS and 11.1% in patients with a CAP; in the same groups, postoperative permanent neurological dysfunction (PND) occurred in 9.6 and 5.6%, respectively. The follow-up was 94.4% complete. For in-hospital survivors, 5- and 10-year survival (%) were 79.4 ± 2.1 and 60.9 ± 3.2, respectively, not influenced by the underlying aortic disease. Cox regression identified age (hazard ratio [HR]: 1.048; P < 0.001), preoperative renal failure (HR: 2.3; P = 0.003), diabetes (HR: 1.805; P = 0.005) and PND (HR: 2.4; P = 0.03) to be independent predictors for the follow-up mortality. Overall, 109 (59% endovascular) aortic reinterventions were performed: 18.3% were proximal and 81.7% distal to the aortic arch. Five- and 10-year freedom from aortic redo (%) were 82.8 ± 1.9 and 77.7 ± 2.6, respectively. Aortic dissection (HR: 1.7; P = 0.03) was the only independent predictor of reoperative surgery at the follow-up.
  
  
  CONCLUSIONS
  Aortic arch surgery was associated with satisfactory early and long-term outcomes. Survival was largely determined by patient comorbidities and postoperative PND. While the underlying aortic disease did not affect long-term mortality, chronic dissection was associated with increased need for aortic reinterventions.
authors.affiliation: Department of Cardiac Surgery, S. Orsola-Malpighi-Hospital, University of Bologna, Bologna, Italy marco.dieusanio2@unibo.it.
authors.forename: Marco
authors.initials: M
authors.lastname: Di Eusanio
authors.affiliation: Department of Cardiac Surgery, S. Orsola-Malpighi-Hospital, University of Bologna, Bologna, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Berretta
authors.affiliation: Department of Cardiac Surgery, S. Orsola-Malpighi-Hospital, University of Bologna, Bologna, Italy.
authors.forename: Mariano
authors.initials: M
authors.lastname: Cefarelli
authors.affiliation: Department of Cardiac Surgery, S. Orsola-Malpighi-Hospital, University of Bologna, Bologna, Italy.
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Castrovinci
authors.affiliation: Department of Cardiac Surgery, S. Orsola-Malpighi-Hospital, University of Bologna, Bologna, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Folesani
authors.affiliation: Department of Cardiac Surgery, S. Orsola-Malpighi-Hospital, University of Bologna, Bologna, Italy.
authors.forename: Jacopo
authors.initials: J
authors.lastname: Alfonsi
authors.affiliation: Department of Cardiac Surgery, S. Orsola-Malpighi-Hospital, University of Bologna, Bologna, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Pantaleo
authors.affiliation: Department of Cardiac Surgery, S. Orsola-Malpighi-Hospital, University of Bologna, Bologna, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Murana
authors.affiliation: Department of Cardiac Surgery, S. Orsola-Malpighi-Hospital, University of Bologna, Bologna, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Di Bartolomeo
mesh_terms: D001013:Aorta, Thoracic / Q000473:pathology / Q000601:surgery*; D001018:Aortic Diseases / Q000401:mortality / Q000473:pathology / Q000601:surgery; D004365:Drugs, Chinese Herbal; D028001:Eleutherococcus; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D004365:Drugs, Chinese Herbal; C400150:Acanthopanax gracilistylus, extract
keywords: Aorta; Aortic arch; Brain protection