title: Hemiarch and Total Arch Surgery in Patients With Previous Repair of Acute Type I Aortic Dissection.
abstract: BACKGROUND
  We examined our contemporary experience with hemiarch and total arch replacement in patients with previous acute type I aortic dissection.
  
  
  METHODS
  Over an 8.5-year period, 137 consecutive patients (median age 58 years, interquartile range, 50 to 67) underwent hemiarch or total transverse aortic arch replacement a median of 7.7 years (range, 67 days to 32 years; interquartile range, 2.8 to 12.3 years) after previous acute type I aortic dissection repair. Interventions involving only the aortic root, aortic valve, descending aorta, or thoracoabdominal aorta were excluded. Multivariate analysis of 20 potential preoperative and intraoperative risk factors was performed to examine early death, neurologic deficit, composite endpoint (operative death, permanent neurologic deficit, or hemodialysis at discharge), and long-term mortality.
  
  
  RESULTS
  Total arch replacement was performed in 103 patients (75.2%), hemiarch replacement in 34 (24.8%), and elephant trunk procedures in 77 (56.2%). Thirty-one repairs (22.6%) were emergent or urgent. There were 16 operative deaths (11.7%), 4 permanent strokes (3.6%), and 21 (15.3%) instances of the composite endpoint. In the multivariate analysis, congestive heart failure and cardiopulmonary bypass time independently predicted operative mortality (p = 0.0027, p = 0.018). Emergency operation approached significance for stroke (p = 0.088). Predictors of long-term mortality (during a median follow-up period of 5.1 years, 95% confidence interval: 4.4 to 5.8) were female sex (p = 0.0036), congestive heart failure (p = 0.0045), and circulatory arrest time (p = 0.0013); preoperative pulmonary disease approached significance (p = 0.074). Five-year survival was 73.2%.
  
  
  CONCLUSIONS
  In patients with previous acute type I aortic dissection repair, hemiarch and total arch operations have respectable morbidity and survival rates. Congestive heart failure predicts operative death, long-term mortality, and our adverse event endpoint. Cardiopulmonary bypass time predicts operative mortality, and female sex and circulatory arrest time predict long-term mortality.
authors.affiliation: Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas; Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas. Electronic address: opsmile01@aol.com.
authors.forename: Ourania
authors.initials: O
authors.lastname: Preventza
authors.affiliation: Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Matt D
authors.initials: MD
authors.lastname: Price
authors.affiliation: Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Katherine H
authors.initials: KH
authors.lastname: Simpson
authors.affiliation: Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas.
authors.forename: Denton A
authors.initials: DA
authors.lastname: Cooley
authors.affiliation: Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas; Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Pocock
authors.affiliation: Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas; Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Kim I
authors.initials: KI
authors.lastname: de la Cruz
authors.affiliation: Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Susan Y
authors.initials: SY
authors.lastname: Green
authors.affiliation: Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas; Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Scott A
authors.initials: SA
authors.lastname: LeMaire
authors.affiliation: Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Todd K
authors.initials: TK
authors.lastname: Rosengart
authors.affiliation: Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas; Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Coselli
mesh_terms: D000208:Acute Disease; D000368:Aged; D001013:Aorta, Thoracic; D001018:Aortic Diseases / Q000145:classification / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014656:Vascular Surgical Procedures / Q000379:methods