Study Population and Definitions
This was a systematic retrospective cohort study of patients undergoing
surgical aortic arch intervention in the setting of extended ascending
aortic pathology at our institution between March 2004 and August 2017.
Patients who underwent isolated ascending aortic replacement with a
closed distal anastomosis were excluded. The Institutional Review Board
of the University of Southern California Health Sciences Campus approved
this study (HS-17-00621) and waived the requirement for patient consent.
Patients baseline demographics, operative characteristics, and
perioperative outcomes were identified through our research database.
The primary endpoints were mortality and need for aortic reintervention.
All medical records from our electronic medical record system were
reviewed. Postoperative complications were defined according to standard
guidelines. 7 All variables are defined inSupplemental Table 1 . Indication for surgery was divided into
dissection, aneurysm, and “other”. The dissection category included
acute and chronic dissection, while the aneurysm category included both
primary aneurysms and pseudoaneurysms. The “other” category included
infections, porcelain aortas, and aorto-esophageal fistulas. Follow up
was considered complete as of the date of last contact.
The entire cohort was divided into two categories based on type of
surgical aortic arch repair. Hemiarch repair was defined as replacement
of the undersurface of the aortic arch, without aortic arch vessel
reconstruction. Total arch repair was defined as the need for
re-implantation of aortic arch vessels either as a contiguous patch
(i.e. Carrel technique) or the need for prosthetic aortic arch vessel
debranching. We also included 4 cases where only the innominate artery
was reimplanted because of the similar complexity of that procedure.
Patients undergoing both emergent/urgent and elective procedures were
included as well as patients with concomitant cardiac procedures.