From January 2002 to December 2010, 321 consecutive patients (mean age 69.8 ¡À 13.3 years) underwent total arch replacement through a median sternotomy at our institute. Aortic dissection was present in 94 (28.3 % ) patients and shaggy aorta in 36 (11.2 % ), with emergency/urgent surgery required in 106 (33.0 % ). Our current approach included the following: (1) meticulous selection of arterial cannulation site and type of arterial cannula; (2) antegrade selective cerebral perfusion; (3) maintenance of minimal tympanic temperature between 20¡ãC and 23¡ãC; (4) early rewarming just after distal anastomosis; (5) after 2004, bolus injection of 100 mg of sivelestat sodium hydrate into the pump circuit at the initiation of cardiopulmonary bypass; (6) after 2006, maintaining fluid balance below 1000 mL during cardiopulmonary bypass.
Overall hospital mortality was 4.4 % (14/321) and was 1.9 % (4/215) in elective cases. Permanent neurologic deficit occurred in 4.4 % (14/321) of patients and in 2.8 % (6/215) of elective cases. Prolonged ventilation was necessary in 53 (16.5 % ), with a significant reduction after 2006 (22.8 % vs 12.6 % ; P?=?.02). Multivariate analysis demonstrated that risk factors for hospital mortality were octogenarian (odds ratio, 4.32; P?=?.03), brain malperfusion (odds ratio, 21.2; P?=?.001) and cardiopulmonary bypass time (odds ratio, 1.01; P?=?.04). Survival at 3 and 5 years after surgery was 82.4 % ¡À 2.5 % and 78.5 % ¡À 3.1 % , respectively.
Our current approach for total aortic arch replacement was associated with low hospital mortality and morbidities and with favorable long-term outcome.