Results
Patient Characteristics and perioperative outcomes for overall cohort
A total of 261 patients are included in this study, of which 149 (57%) underwent hemiarch and 112 (43%) underwent total arch repair. Preoperative and operative characteristics are shown in Tables 1 and 2 . In the overall cohort, median age was 60.6 (IQR 52.7 – 70.0) with a predominance of males, smokers, and those with hypertension. Acute aortic dissection was the predominant indication for surgery (66.3%). Those undergoing hemiarch and total arch repair were of similar age and body mass index (BMI), and had similar frequencies of hyperlipidemia, chronic obstructive pulmonary disease, chronic dialysis, previous stroke, and history of heart failure. Those undergoing hemiarch repair were more likely to be males, have hypertension, diabetes, peripheral artery disease, a prior myocardial infarction, and dissection as the operative indication.
Operative characteristics are notable for a similar proportion of reoperative surgery in both groups (35.7 vs. 25.7%, p=0.16, total arch vs. hemiarch). Type of proximal aortic repair was likewise similar in both groups with relatively equal distribution of isolated aortic replacement (at sinotubular junction), aortic replacement with aortic valve replacement, and aortic root replacement. Those undergoing hemiarch replacement were more likely to have an urgent/emergent operative indication and to have shorter cardiopulmonary bypass, aortic cross clamp, and antegrade cerebral perfusion times. Cerebral protection was used with similar frequency in both groups, with axillary cannulation and antegrade cerebral perfusion predominating in our recent series. Thirty-one (11.9%) of those undergoing total arch replacement had and elephant trunk.
In-hospital and 30-day mortality were significantly higher in those undergoing total arch replacement. In-hospital mortality was 5.4% in the hemiarch group versus 13.4% in the total arch group (P=0.024). 30-day mortality was 4.7% in the hemiarch group versus 14.3% in the total arch group (p=0.018). Vocal cord paralysis was more common in the total arch group, while other perioperative outcomes (use of ECMO, stroke, paraplegia, reoperation for bleeding, pneumonia, open chest) were similar between groups.