Study Population and Definitions
This was a systematic retrospective cohort study of patients undergoing surgical aortic arch intervention in the setting of extended ascending aortic pathology at our institution between March 2004 and August 2017. Patients who underwent isolated ascending aortic replacement with a closed distal anastomosis were excluded. The Institutional Review Board of the University of Southern California Health Sciences Campus approved this study (HS-17-00621) and waived the requirement for patient consent.
Patients baseline demographics, operative characteristics, and perioperative outcomes were identified through our research database. The primary endpoints were mortality and need for aortic reintervention. All medical records from our electronic medical record system were reviewed. Postoperative complications were defined according to standard guidelines. 7 All variables are defined inSupplemental Table 1 . Indication for surgery was divided into dissection, aneurysm, and “other”. The dissection category included acute and chronic dissection, while the aneurysm category included both primary aneurysms and pseudoaneurysms. The “other” category included infections, porcelain aortas, and aorto-esophageal fistulas. Follow up was considered complete as of the date of last contact.
The entire cohort was divided into two categories based on type of surgical aortic arch repair. Hemiarch repair was defined as replacement of the undersurface of the aortic arch, without aortic arch vessel reconstruction. Total arch repair was defined as the need for re-implantation of aortic arch vessels either as a contiguous patch (i.e. Carrel technique) or the need for prosthetic aortic arch vessel debranching. We also included 4 cases where only the innominate artery was reimplanted because of the similar complexity of that procedure. Patients undergoing both emergent/urgent and elective procedures were included as well as patients with concomitant cardiac procedures.