Sharma, Varun J; Kanagarajah, Abbie R; Seevanayagam, Siven; Kim, Michelle; Matalanis, George

doi:10.1016/j.athoracsur.2022.09.020

Author(s)

Sharma, Varun J

Kanagarajah, Abbie R

Seevanayagam, Siven

Kim, Michelle

Matalanis, George

Publication Date

2023-08

Abstract

Aortic arch surgery necessitates interruption of perfusion, thus conferring higher morbidity and mortality compared with other aortic surgery. This report describes a branch-first continuous perfusion aortic arch replacement (BF-CPAR) technique that overcomes these shortcomings and describes midterm results with this technique. This report represents the corresponding author's 15-year experience with BF-CPAR, which involves preliminary mobilization and branch reconstruction before circulatory arrest by using a modified trifurcation graft. Demographic, procedural, and outcome (mortality, reintervention, morbidity, and stroke) were analyzed with Kaplan-Meier and Cox regression. Over 15 years (July 2005-February 2021), 155 patients underwent BF-CPAR, at a median age of 66.8 years, 106 (68.3%) on an elective basis and 49 (31.6%) on an emergency basis. There were no aortic deaths after the first postoperative year, thereby resulting in a 1- and 10-year freedom from aortic death constant at 95.6% in patients undergoing elective BF-CPAR and 93.3% in patients undergoing emergency BF-CPAR patients, respectively. Freedom from reintervention on the operated segment at 5 and 9 years was 93.2% and 93.2% in patients undergoing elective cases and 97.1% and 91.4% in emergency cases, respectively. The 10-year freedom from any aortic reintervention was 72.8% in elective patients and 29.2% in emergency patients; there were 38 reinterventions, 76.3% (n = 29/38) done for progression of aneurysmal or dissection disease, of which 79.3% (n = 23/29) were completed endovascularly. Freedom from cerebrovascular-related events at 5 and 10 years was 90.3% and 82.6% in patients undergoing elective BF-CPAR and 75.4% for both time points in patients undergoing emergency BF-CPAR, respectively. BF-CPAR has excellent 10-year results for elective and emergency cases of arch replacement.

Citation

The Annals of Thoracic Surgery 2023-08; 116(2)

ISSN

1552-6259

Jornal Title

The Annals of Thoracic Surgery

OrcId

#PLACEHOLDER_PARENT_METADATA_VALUE#

Link

https://ahro.austin.org.au/austinjspui/handle/1/34084

Title

Branch-first Continuous Perfusion Aortic Arch Replacement: Midterm Results.

Type of document

Journal Article

Austin Health

Branch-first Continuous Perfusion Aortic Arch Replacement: Midterm Results.

Files:

Author(s)	Sharma, Varun J Kanagarajah, Abbie R Seevanayagam, Siven Kim, Michelle Matalanis, George
Publication Date	2023-08
Abstract	Aortic arch surgery necessitates interruption of perfusion, thus conferring higher morbidity and mortality compared with other aortic surgery. This report describes a branch-first continuous perfusion aortic arch replacement (BF-CPAR) technique that overcomes these shortcomings and describes midterm results with this technique. This report represents the corresponding author's 15-year experience with BF-CPAR, which involves preliminary mobilization and branch reconstruction before circulatory arrest by using a modified trifurcation graft. Demographic, procedural, and outcome (mortality, reintervention, morbidity, and stroke) were analyzed with Kaplan-Meier and Cox regression. Over 15 years (July 2005-February 2021), 155 patients underwent BF-CPAR, at a median age of 66.8 years, 106 (68.3%) on an elective basis and 49 (31.6%) on an emergency basis. There were no aortic deaths after the first postoperative year, thereby resulting in a 1- and 10-year freedom from aortic death constant at 95.6% in patients undergoing elective BF-CPAR and 93.3% in patients undergoing emergency BF-CPAR patients, respectively. Freedom from reintervention on the operated segment at 5 and 9 years was 93.2% and 93.2% in patients undergoing elective cases and 97.1% and 91.4% in emergency cases, respectively. The 10-year freedom from any aortic reintervention was 72.8% in elective patients and 29.2% in emergency patients; there were 38 reinterventions, 76.3% (n = 29/38) done for progression of aneurysmal or dissection disease, of which 79.3% (n = 23/29) were completed endovascularly. Freedom from cerebrovascular-related events at 5 and 10 years was 90.3% and 82.6% in patients undergoing elective BF-CPAR and 75.4% for both time points in patients undergoing emergency BF-CPAR, respectively. BF-CPAR has excellent 10-year results for elective and emergency cases of arch replacement.
Citation	The Annals of Thoracic Surgery 2023-08; 116(2)
ISSN	1552-6259
Jornal Title	The Annals of Thoracic Surgery
OrcId	#PLACEHOLDER_PARENT_METADATA_VALUE# #PLACEHOLDER_PARENT_METADATA_VALUE# #PLACEHOLDER_PARENT_METADATA_VALUE# #PLACEHOLDER_PARENT_METADATA_VALUE# #PLACEHOLDER_PARENT_METADATA_VALUE#
Link	https://ahro.austin.org.au/austinjspui/handle/1/34084
Title	Branch-first Continuous Perfusion Aortic Arch Replacement: Midterm Results.
Type of document	Journal Article