Management of extensive lesions of the aortic arch - Review of 42 consecutive cases

This retrospective study reviews the long-term results in aortic arch surge ry. Forty-two consecutive patients (44-74 years) were operated on between 1 980 and 1995. Nineteen patients had acute dissections of the aortic arch, 1 1 had chronic dissections and 12 had aneurysms. Twenty patients were given emergency surgery and 22 were operated on electively. Reconstruction of the aortic arch alone (31%) or with other aortic segments (69%) was performed during antegrade cerebral perfusion (81%) or circulatory arrest (17%). Sixt een patients died during the first 30 days (38%). Early mortality rates wer e 60% in emergencies and 18% in elective cases. Early mortality in the grou p with aneurysms was 33% and 40% in patients in the dissection group. Long- term follow-up to July 1998 is now complete. Twelve patients (28%) died dur ing the: follow-up period; 4 of these deaths were due to a rupture of the d escending aorta. Three patients (11.5%) underwent late reoperations on the remaining aorta, without operative mortality. We recommend careful follow-u p of patients with aortic arch disease and, when indicated, surgery to avoi d the rupture of the remaining aorta.