Repair of aortic arch and the impact of cross-clamping time, New York Heart Association stage, circulatory arrest time, and age on operative outcome

BACKGROUND: Aortic arch replacement is associated with high morbidity and mortality. METHODS: We evaluated the postoperative complications and risk factors in 32 consecutive patients after aortic arch replacement. RESULTS: The mean age was 61+/-15 years and male to female ratio was 24/8. Diameter of ascending aorta was 6.0+/-0.8 cm and diameter of aortic arch was 5.2+/-1.2 cm. The average New York heart association (NYHA) class was 2+/-1. The 30-day mortality was 6.2% (2 of 32 patients), one patient died intraoperatively (3%); all surviving 30 patients had f/u for at least six months, a total of 3 of 32 patients had died within six months, actuarial survival was 90% at six months. The overall incidence of neurologic adverse events was 9%; however, only one patient had a cerebrovascular accident (CVA) with a focal deficit (3%). The other two patients had global neurologic dysfunction. Other significant postoperative complications included atrial fibrillation in 15 patients (46%), ventricular fibrillation requiring cardiopulmonary resuscitation (CPR) in one patient (3%), and pericardial effusion requiring pericardicentesis in eight patients (25%). The need for blood transfusion correlated with the cross-clamping length (Pearson r 0.62; 95% confidence interval (CI), 0.35-0.79; P-value 0.0001; R(2)=0.38). Cross-clamp time (139+/-58 min) did not have an impact on length of intensive care unit (ICU) stay (Pearson r -0.09; 95% CI -0.39-0.23; P=0.58; R(2)=0.008) nor did the length of circulatory arrest (95% CI -0.44-0.21, P=0.44). The length of stay in the ICU (142+/-128 h) correlated with the NYHA stage of the patient (95% CI 0.001-0.62, P=0.04). The length of stay (LOS) (12+/-6 days) correlated with age of the patients (95% CI 0.03-0.57, P=0.03). CONCLUSION: Elderly patients and patients with high NYHA class need close postoperative monitoring in the ICU. A short circulatory arrest and aortic clamp time do not extend the LOS in ICU or in the hospital.