Research Article|Articles in Press

Short- and Long-Term Results of Total Arch Replacement: Comparison Between Island and Debranching Techniques

Open AccessPublished:May 24, 2023DOI:
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      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.


      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.


      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].


      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.


      Glossary of Abbreviations:

      MAE (Major adverse event), OR (Odds ratio), CI (Confidence interval), COPD (Chronic obstructive pulmonary disease), HR (Hazard ratio)