Introduction
The optimal approach to aortic arch repair in the setting of ascending
aortic disease remains controversial and continues to evolve, especially
in the setting of acute aortic dissection. While some advocate for
replacement of the entire aortic arch during extended replacement of the
ascending aorta1-3, others restrict aortic arch repair
to those settings in which aortic pathology exists4-6.
Proponents of the former approach argue that a more aggressive approach
to the aortic arch prevents the need for subsequent reintervention and
potentially leads to better long-term outcomes. Others argue that absent
aortic arch pathology, total arch replacement is associated with
increased morbidity and mortality and may not decrease the need for
further aortic reintervention or result in improved long-term survival.
Our custom has been to perform a hemiarch operation whenever possible,
as long as it fully addresses the indication for operation. Total arch
replacements are reserved for aortic dissections with tears in the arch,
or aneurysms and other aortic arch pathology that involve the aortic
branches. This study compares our results with hemiarch vs. total arch
replacements in 261 consecutive operations for primary ascending aortic
pathology with the objective to identify preoperative and operative
factors associated with mortality and need for aortic reintervention.