The Addition of Aortic Root Procedures during Elective Arch Surgery Does Not Confer Added Morbidity nor Mortality

Abstract

Background During elective aortic arch replacement, the addition of an aortic root procedure has an unknown effect on morbidity and mortality. The purpose of this study is to determine the effect of adding an aortic root procedure to elective aortic surgery using the ARCH international database.

Methods The ARCH Database was queried for all elective aortic arch replacements with and without aortic root replacement using moderate hypothermic circulatory arrest and antegrade cerebral perfusion from 2000-2015. Propensity score matching analysis was used to balance covariates, and a logistic regression model was created.

Results 1169 patients were included for analysis, and 320 (27.4%) underwent an aortic root procedure. Patients undergoing root procedures were younger (69 vs. 61), had less coronary artery disease (20% vs. 32%) and had a higher incidence of Marfan’s syndrome (4.2% vs. 10.0%) (p<0.001 for both). Concomitant CABG (26.6% vs. 19.7%), total aortic arch replacement (41.6% vs. 84.3%), and elephant trunk procedures (46% vs. 17.2%) were performed more frequently in the non-root cohort, (p<0.001 for both). Cardiopulmonary bypass and aortic crossclamp times were significantly longer in the cohort who underwent root procedures while cerebral perfusion times were longer in the non-root cohort (p<0.001 for all). In both the propensity matched and non-matched analyses, postoperative outcomes were not significantly different between patients who underwent root procedures and those who did not (p>0.05 for all outcomes). Multivariable logistic regression analyses showed no difference in mortality rates (Odds ratio 0.62 [0.9-1.34], p=0.22) nor in rates of permanent stroke (Odds ratio 0.89 [0.36-2.24], p=0.81) between root and non-root cohorts.

Conclusions The addition of an aortic root procedure during elective aortic arch surgery lengthens cardiopulmonary bypass and aortic crossclamp times but does not increase postoperative morbidity nor mortality.