title: Open Surgical Repair Remains the Gold Standard for Treating Aortic Arch Pathology.
abstract: BACKGROUND
  Endovascular arch repair technology is driven in large part by the assumption that open arch operations are high-risk. We wanted to evaluate the clinical results of open arch reconstruction in the modern era in a large group practice.
  
  
  METHODS
  From October 2003 to June 2014, 567 patients underwent aortic arch operations: hemiarch repair was performed in 429 patients (75.7%; group A), total arch repair in 129 (22.7%; group B), and patch repair in the remaining 9 (1.6%). The procedure was an emergency in 88 patients (20.5%) in group A and in 41 patients (31%) in group B. Redo sternotomy after a previous aortic operation was performed in 35 patients (8.2%) in group A and in 28 patients (22%) in group B.
  
  
  RESULTS
  Permanent neurologic deficits were diagnosed in 12 patients (2.8%) in group A and in 3 patients (2.4%) in group B. No spinal cord injuries occurred. Mortality at 30 days was 4% (17 patients) in group A and 5.4% (7 patients) in group B. Patients in group A were younger than in group B (mean age, 61.3 vs 63.6 years; p = 0.06). Older age (odds ratio, 1.05; 95% confidence interval, 1.01 to 1.09; p = 0.0087) and extracorporeal circulation time (odds ratio, 1.01; 95% confidence interval, 1 to 1.01; p < 0.001) were predictors of perioperative 30-day mortality. Age (odds ratio, 1.05; 95% confidence interval, 1.01 to 1.08; p = 0.006) was the only predictor for neurologic dysfunction. Survival at 2, 6, and 8 years was 90%, 80%, and 69%, respectively, for group A, and 85%, 70% and 62%, respectively, for group B.
  
  
  CONCLUSIONS
  These results set a standard against which endovascular technology needs to be compared.
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota.
authors.forename: Vishal
authors.initials: V
authors.lastname: Khullar
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota.
authors.forename: Hartzell V
authors.initials: HV
authors.lastname: Schaff
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Dearani
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota.
authors.forename: Richard C
authors.initials: RC
authors.lastname: Daly
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota.
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Greason
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota.
authors.forename: Lyle D
authors.initials: LD
authors.lastname: Joyce
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota. Electronic address: pochettino.alberto@mayo.edu.
authors.forename: Alberto
authors.initials: A
authors.lastname: Pochettino
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000601:surgery*; D001019:Aortic Rupture / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation; D001921:Brain / Q000098:blood supply; D001925:Brain Damage, Chronic / Q000175:diagnosis / Q000209:etiology / Q000401:mortality; D002545:Brain Ischemia / Q000175:diagnosis / Q000209:etiology / Q000401:mortality; D002315:Cardiopulmonary Bypass; D005260:Female; D006324:Heart Arrest, Induced; D061847:Hospitals, High-Volume; D006801:Humans; D007036:Hypothermia, Induced; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000401:mortality; D012086:Reoperation; D012189:Retrospective Studies; D056346:Sternotomy; D015996:Survival Rate; D055815:Young Adult