title: Contemporary results of hemiarch replacement.
abstract: OBJECTIVE
  Our goal was to report on early and midterm outcomes of hemiarch replacement performed in a high-volume centre.
  
  
  METHODS
  We extrapolated hemiarch replacements from our institutional aortic database. We also analysed the impact of aortic disease (dissection vs aneurysm) on the outcomes of de novo hemiarch replacement.
  
  
  RESULTS
  A total of 756 patients underwent hemiarch replacement between 1997 and 2016. After elimination of cases involving the aortic root/valve and redo cases, we identified 426 cases of de novo -isolated hemiarch replacement (369 aneurysms and 57 dissections). Overall operative mortality was 3.1% (13 of 426). The most frequent complications were respiratory failure requiring tracheostomy (11 of 426, 2.6%) and renal failure requiring dialysis (7 of 426, 1.6%). On regression analysis, previous myocardial infarction was the only independent predictor of major adverse events (odds ratio 3.14; 95% confidence interval 1.36-7.22; P  = 0.007). Operative mortality was 5.3% (3 of 57) for dissections and 2.7% (10 of 369) for aneurysms ( P  = 0.29). The postoperative need for tracheostomy and for new dialysis was more frequent in the dissection group (4 of 57 vs 7 of 369; P  = 0.02 and 3 of 57 vs 4 of 369; P  = 0.02, respectively). At 5 years, the overall survival rate was 72.5% (95% confidence interval 66.4-78.6%), and there was no difference in survival and risk of reoperation between the 2 groups ( P  = 0.97).
  
  
  CONCLUSIONS
  In high-volume centres, aortic hemiarch replacement can be performed with excellent results. The aortic disease only partially affects the early and midterm outcomes.
authors.affiliation: Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA.|Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK.
authors.forename: Ivancarmine
authors.initials: I
authors.lastname: Gambardella
authors.affiliation: Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA.
authors.forename: Mario
authors.initials: M
authors.lastname: Gaudino
authors.affiliation: Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Lau
authors.affiliation: Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA.
authors.forename: Monica
authors.initials: M
authors.lastname: Munjal
authors.affiliation: Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA.
authors.forename: Antonino
authors.initials: A
authors.lastname: Di Franco
authors.affiliation: Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA.
authors.forename: Lucas B
authors.initials: LB
authors.lastname: Ohmes
authors.affiliation: Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA.
authors.forename: Fawad
authors.initials: F
authors.lastname: Hameedi
authors.affiliation: Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Glasgow, UK.
authors.forename: Cristiano
authors.initials: C
authors.lastname: Spadaccio
authors.affiliation: Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA.
authors.forename: Leonard N
authors.initials: LN
authors.lastname: Girardi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000453:epidemiology / Q000601:surgery*; D001011:Aorta / Q000601:surgery*; D001014:Aortic Aneurysm / Q000453:epidemiology / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Aortic aneurysm; Aortic dissection ; Aortic surgery ; Arch replacement ; Hemiarch 