title: Early and mid-term outcomes of the aortic arch surgery: experience from the low-volume centre.
abstract: OBJECTIVE
  The aim of this retrospective study was to examine the early and mid-term outcomes for patients undergoing elective aortic arch surgery over a 13-years period in the single low-volume centre. Results of aortic arch surgery published in the literature are usually results of high-volume centers, but the majority of institutions have much lower caseload.
  
  
  METHODS
  From January 1999 to March 2013 total of 353 surgeries on thoracic aorta were performed in our institution. Only 30 procedures (8.5%) were elective aortic arch surgeries. This group of patients was analyzed.
  
  
  RESULTS
  Deep hypothermia alone and hypothermia with ortograde cerebral perfusion was used in 7 (23%) and 23 (77%) patients respectively. Mean core temperature was 22°C (17 - 26°C). Cannulation sites was axillary artery or brachiocephalic trunk in 17 (57%), femoral artery in 8 (27%) and ascending aorta or aortic arch in 5 (16%). Mean hypothermic circulatory arrest time was 39 min (15 - 74 min). There was one death due to multiorgan failure; all-cause mortality at 30 days was 3.3%. The frequency of other complications was permanent neurological deficit in 2 (6.7%), temporary neurological deficit in 2 (6.7%) and renal failure requiring hemodialysis in 2 (6.7%) patients. In the follow-up 13 patients died, remaining 16 are still alive.
  
  
  CONCLUSIONS
  Despite the lower caseload and technical problems manifested by a higher number of re-operations for bleeding, the all-cause mortality at 30 days as well as mid-term results are comparable with results reported by the high-volume centres.
authors.affiliation: Department of Cardiac Surgery, University Hospital in Ostrava, 17. listopadu 1790, 708 52, Ostrava, Czech Republic. radim.brat@fno.cz.|Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic. radim.brat@fno.cz.
authors.forename: Radim
authors.initials: R
authors.lastname: Brat
authors.affiliation: Department of Cardiac Surgery, University Hospital in Ostrava, 17. listopadu 1790, 708 52, Ostrava, Czech Republic. jargaj@post.cz.
authors.forename: Jaroslav
authors.initials: J
authors.lastname: Gaj
authors.affiliation: Department of Cardiac Surgery, University Hospital in Ostrava, 17. listopadu 1790, 708 52, Ostrava, Czech Republic. jiribarta.klimkovice@seznam.cz.
authors.forename: Jiri
authors.initials: J
authors.lastname: Barta
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods* / Q000592:standards; D002404:Catheterization; D002560:Cerebrovascular Circulation; D002983:Clinical Competence; D017558:Elective Surgical Procedures / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010477:Perfusion / Q000379:methods; D011184:Postoperative Period; D012189:Retrospective Studies; D016896:Treatment Outcome; D016526:Workload / Q000706:statistics & numerical data