title: Single-centre experience in surgery of acute aortic type A dissection and true aortic arch aneurysm.
abstract: BACKGROUND
  Surgery of the aortic arch is challenging.
  
  
  OBJECTIVE
  To assess the results of aortic arch surgery.
  
  
  METHODS
  Analysis of 172 patients operated on arch dissection (emergency group: 97 patients) or aneurysm (elective group: 75 patients) between 2007 and 2014. Arch surgery was defined as a procedure requiring circumferential anastomosis at the level of the aortic arch or the descending aorta with the use of techniques of brain protection (deep hypothermic circulatory arrest [DHCA] or selective antegrade cerebral perfusion [SACP]) and/or debranching of at least one supra-aortic vessel.
  
  
  RESULTS
  Men predominated in both groups (> 70%). Men were younger in the emergency group (55 vs. 66 years; p < 0.008). The operative risk was higher in the emergency group (19.2% vs. 12.5%; p < 0.001). Forty-nine per cent of the patients from the emergency group and 5% from the elective group were operated with antiplatelet therapy (p < 0.001). Extended hemiarch procedure was performed in 79% (n = 77) in the emergency and 76% (n = 57) in the elective group. Total arch replacement was performed in 19 (21%) patients from the emergency and 18 (24%) patients from the elective group. In these patients debranching was performed in 68% of the emergency patients group and in 67% of the elective group. Elephant trunk procedure (classic/frozen) was performed in 53% (n = 10) from the emergency and in 78% (n = 14) of patients from the elective group. Aortic valve sparing surgery was performed in 20% of patients from the emergency and 9% from the elective group (p = 0.063). DHCA was performed in 58% (n = 43) of patients from the elective group and 39% (n = 37) from the emergency group. SACP was performed in 61% (n = 58) of patients from the emergency and 42% (n = 31) from the elective group. Thirty-day mortality in the emergency group reached 33% (n = 32), and in the elective group 15% (n = 11; p = 0.007). In multivariate analysis, predictors of death in the emergency group were: Logistic EuroSCORE above 19.5%, extracorporeal circulation time above 228 min, and postoperative acute renal failure (ARF); and in the elective group: DHCA time above 26 min, rethoracotomy due to bleeding, and ARF. Follow-up was completed in 100% of patients in terms of vital status. The mean follow-up time of the patients from the emergency group was 24.3 ± 27.10 (min 0, max 92) months, and from the elective group 30.3 ± 24.5 (min 0, max 99) months. During the follow-up period all-cause mortality in the emergency group was 43% (n = 42/97), and in the elective group it was 36% (n = 27/75).
  
  
  CONCLUSIONS
  Early mortality in the emergency group was higher, while long-term mortality did not differ among the groups. Postoperative ARF is a critical predictor of mortality in both groups.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Hirnle
authors.affiliation: Uniwersytet Medyczny w Białymstoku. stankiewiczad@wp.pl.
authors.forename: Adrian
authors.initials: A
authors.lastname: Stankiewicz
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Matlak
authors.forename: Marek
authors.initials: M
authors.lastname: Frank
authors.forename: Robert
authors.initials: R
authors.lastname: Trzciński
authors.forename: Anna
authors.initials: A
authors.lastname: Lejko
authors.forename: Arkadiusz
authors.initials: A
authors.lastname: Niedźwiecki
authors.forename: Maciej
authors.initials: M
authors.lastname: Mitrosz
authors.forename: Iwona
authors.initials: I
authors.lastname: Dmitruk
authors.forename: Marta
authors.initials: M
authors.lastname: Milewska-Buzun
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Hirnle
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D050792:Circulatory Arrest, Deep Hypothermia Induced; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011044:Poland; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000401:mortality / Q000706:statistics & numerical data*
keywords: acute aortic dissection; aortic aneurysm; aortic arch surgery; protection of central nervous system