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Abstract
Objective
The two most acceptable techniques for reimplantation of the supra-aortic vessels in total arch replacement (TAR) include the branched graft technique (Debranching) or en-bloc technique (island). We aim to review our experience with TAR and report short- and long-term outcomes from a high-volume center dedicated to surgery for the thoracic aorta.
Methods
The aortic surgery database was queried to identify all consecutive patients undergoing TAR between 1997 and 2022. Of the 426 patients who underwent TAR, 303 (71%) had the island technique and 123 (29%) the debranching approach. Operative and long-term outcomes were compared using multivariable models.
Results
The debranching group was younger (64±14 vs. 69±12, p=0.001), had undergone more previous cardiac operations (54.5% vs. 27.4%, p<0.001) and had more connective tissue disorder (20.3% vs. 4.6%, p<0.001). The debranching approach was associated with longer total circulatory arrest (47±15 vs. 37±10 minutes, p<0.001) and cardiac ischemic (116±41 vs. 100±37 minutes, p<0.001) times. More patients in the debranching group received blood products intra- or post-operatively (56.1% vs. 42.9%, p=0.018). All other early outcomes did not differ between groups. Overall operative mortality was 1.4% (2.4% vs. 1%, p=0.486); the incidence of major postoperative complications was 6.3% (5.7% vs. 6.6%, p=0.897). Ten-year survival was 80% (78% vs. 80.9%, log-rank p=0.356). Multivariable Cox regression analysis demonstrated that neither surgical approach was associated with survival advantage [HR 1.18 (0.73-1.89), p=0.495].
Conclusion
Debranching requires longer operative time, with similar early and long-term outcomes. Preoperative comorbidity and not surgical technique, predicts major adverse events and long-term survival.
Keywords
Glossary of Abbreviations:
MAE (Major adverse event), OR (Odds ratio), CI (Confidence interval), COPD (Chronic obstructive pulmonary disease), HR (Hazard ratio)Article info
Publication history
Accepted:
May 15,
2023
Received:
February 28,
2023
Publication stage
In Press Journal Pre-ProofFootnotes
Will be presented at the 2023 AATS Annual Meeting.
There is no conflict of interests regarding the publication of this manuscript. No funding was provided for this study by any source and there is no relationship with industry.
Identification
Copyright
© 2023 The Authors. Published by Elsevier Inc. on behalf of The American Association for Thoracic Surgery
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