Total Arch Replacement Using the Trifurcation Graft, Antegrade Cerebral Perfusion in the Era of Endovascular Surgery
Ioannis Paralikas1, Oleg Orlov1, Jessica Grippaldi2, Grace E. Kim2, Louis E. Samuels1, Konstadinos Plestis1. 1Lankenau Heart Institute, Wynnewood, PA USA, 2Villanova University, Villanova, PA USA.
Objective: To evaluate the impact of hypothermic circulatory arrest (HCA), antegrade cerebral perfusion (ACP) and the utilization of trifurcation graft (TG) in the outcomes of patients who underwent total aortic arch replacement (TAAR).
Methods: This is a retrospective analysis of prospectively collected data from 70 patients who underwent TAAR between 2005 and 2014. There were 39(53.4%) male patients (mean age 62.2 ±16). Thirty (41%) patients had aortic dissections (10 Acute and 20 Chronic), 29 (40%) had medial degeneration and 3 (4%) had Marfan €™s syndrome. Out of thirty three (59%) patients who had previous cardio-aortic surgery, 5(6.9%) had aortic valve replacement, 17(23.3%) had ascending aortic replacement and 5(6.9%) had composite valve replacement.
Results: The mean pump time was 216 ±76, mean aortic cross clamp time was 128 ±70, mean circulatory arrest time was 21.3 ±18, and mean antegrade cerebral perfusion time was 58 ±30 minutes. The hospital mortality was 7%(5 patients). Three (4%) patients had stroke, 5(6.9%) had transient neurologic dysfunction, 6(8.22%) had new onset of renal insufficiency and 31(44.2%) had prolonged ventilatory support ( ‰¥48 hours) postoperatively. Reoperation for bleeding was required in 8(11.4%) patients.
Ten (15.4%) patients died during the follow-up (mean: 714.2 ±507.8 days). The survival probability at 1 year is 0.997, 3 years is 0.86 and at 5 years is 0.817.
Conclusions: The utilization of HCA, ACP and the trifurcation graft has led to excellent perioperative and midterm outcomes for patients undergoing TAAR.