Impact of reimplantation technique of supra-aortic branches in total arch replacement on stroke rate and survival: results from the ARCH registry. (8th May 2018)

• Record Type: Journal Article
• Authors: Schoenhoff, Florian S; Tian, David H; Misfeld, Martin; Perreas, Konstantinos G; Spielvogel, David; Mohr, Friedrich W; Beyersdorf, Friedhelm; Yan, Tristan D; Carrel, Thierry P
• Is Part Of: European journal of cardio-thoracic surgery. Volume 54:Number 6(2018)
• Page Start: 1045
• Page End: 1051
• Publication Date: 2018-05-08
• Subjects: Aortic arch -- Aortic dissection -- Aortic arch aneurysm -- Aortic arch replacement; Heart -- Surgery -- Periodicals; Chest -- Surgery -- Periodicals; 617.54
• DOI: 10.1093/ejcts/ezy194
• Languages: English
• ISSNs: 1010-7940

Abstract

Abstract: OBJECTIVES: Our objective was to evaluate the impact of reimplantation techniques of the supra-aortic branches in total arch replacement on the rates of permanent neurological deficit (PND) and survival. METHODS: We identified patients enrolled in the ARCH registry who underwent total arch replacement between 2000 and 2015 with either en bloc or separate reimplantation of the supra-aortic branches. RESULTS: A total of 3345 patients were included in the present analysis. From this cohort, 686 patients underwent en bloc and 2659 patients had separate reimplantation of the supra-aortic branches. Propensity score analysis identified 461 matched patient pairs. In the matched cohort, there were no differences regarding the mortality rate (15.6% vs 15.7%, P = 0.710) or PND (9.2% vs 12.1%, P = 0.231). Although separate reimplantation of the supra-aortic branches was not associated with an increased mortality rate on multivariable logistic regression, it increased the risk of PND [odds ratio (OR) 1.56, 95% confidence interval (CI) 1.06–2.29; P = 0.023]. Propensity-adjusted regression confirmed these findings and found a similar risk for PND with separate reimplantation of the supra-aortic branches (OR 1.50, 95% CI 1.01–2.23; P = 0.047), although this significance was not found with conditional logistic regression ( P = 0.20). No significant differences between survival were seen between the 2 matched cohorts (stratified log rank P = 0.35). CONCLUSIONS: Separate reimplantation of the supra-aortic branches in total arch replacement is a significant predictor of stroke in the overall group, although comparable stroke rates were observed in the matched cohort. The current trend towards separate reimplantation of supra-aortic branches may expose certain subgroups of patients to an increased risk of stroke, e.g. those with a high atherosclerotic burden.