Short and Long-term Outcomes after Total Arch Replacement by Using the Trifurcated Graft Technique, Antegrade Cerebral Perfusion and Deep Hypothermia Circulatory Arrest
Cinthia P. Orlov, Manabu Takebe, Oleg I. Orlov, Matthew Thomas, Vishal N. Shah, Sophia Strine, Konstadinos A. Plestis, Lankenau Medical Center, Wynnewood, PA, USA
OBJECTIVE: To evaluate short and long-term outcomes of total arch replacement using the trifurcated graft technique, antegrade cerebral perfusion and deep hypothermic circulatory arrest.
METHODS: We reviewed 77 patients (42 males, 54%) who underwent total arch replacement with antegrade cerebral perfusion and deep hypothermia circulatory arrest from January 2005 to December 2017. Deep hypothermic circulatory arrest was achieved between 18-22 °C. All patients had antegrade cerebral perfusion either immediately after circulatory arrest (perfusion first) or after completion of the distal anastomosis (surgery first). Trifurcation grafts were utilized in 44 (57%) patients and bifurcation grafts were utilized in 33 (43%) patients. Indications for surgical repair included degenerative aneurysms in thirty (38%) patients, chronic dissection in 25 (32%), acute dissection in 15 (19%) and atherosclerotic aneurysms in 10 (13%). Thirty-one (40%) patients had undergone previous cardiac surgery.
RESULTS: Hospital mortality was 5% (4 patients). Postoperative stroke and transient ischemic attack occurred in 3 (4%) patients. Renal insufficiency occurred in 10 (13%) patients. Mean circulatory arrest time was 18 ±15 minutes and mean antegrade cerebral perfusion time was 60 ±21 minutes. The median duration of intensive care and hospital length of stay was 6 and 15 days respectively. Ninety percent of patients were alive at 1 year, 76% at 5 years and 68% at 10 years.
CONCLUSIONS: In the era of hybrid and endovascular repair, open total arch replacement utilizing the trifurcated graft technique, antegrade cerebral perfusion and deep hypothermic circulatory arrest offers outstanding short-term outcomes in addition to good long-term survival rates (Figure 1).
Kaplan-Meier Survival Curve Showing Survival after Total Arch Replacement Performed Utilizing Either Perfusion First or Surgery First Techniques