Abstract
AimThe aim of this retrospective study was to examine the early and mid-term outcomes for patients undergoing elective aortic arch surgery over a 13-years period in the single low-volume centre. Results of aortic arch surgery published in the literature are usually results of high-volume centers, but the majority of institutions have much lower caseload.MethodsFrom January 1999 to March 2013 total of 353 surgeries on thoracic aorta were performed in our institution. Only 30 procedures (8.5%) were elective aortic arch surgeries. This group of patients was analyzed.ResultsDeep hypothermia alone and hypothermia with ortograde cerebral perfusion was used in 7 (23%) and 23 (77%) patients respectively. Mean core temperature was 22°C (17 – 26°C). Cannulation sites was axillary artery or brachiocephalic trunk in 17 (57%), femoral artery in 8 (27%) and ascending aorta or aortic arch in 5 (16%). Mean hypothermic circulatory arrest time was 39 min (15 – 74 min). There was one death due to multiorgan failure; all-cause mortality at 30 days was 3.3%. The frequency of other complications was permanent neurological deficit in 2 (6.7%), temporary neurological deficit in 2 (6.7%) and renal failure requiring hemodialysis in 2 (6.7%) patients. In the follow-up 13 patients died, remaining 16 are still alive.ConclusionDespite the lower caseload and technical problems manifested by a higher number of re-operations for bleeding, the all-cause mortality at 30 days as well as mid-term results are comparable with results reported by the high-volume centres.
Highlights
There has been great interest in general and cardiac surgery with respect to the relationship between caseload and clinical outcome [1]
It has been suggested that mortality rates might be reduced by 20–50% for a range of procedures including carotid endarterectomy, abdominal aortic aneurysm repair, pancreatectomy and oesophagectomy if carried out by high volume surgical groups [2]
When comparing results of aortic arch surgery, we have to take into consideration the percentage of acute dissection in the series
Summary
There has been great interest in general and cardiac surgery with respect to the relationship between caseload and clinical outcome [1]. It has been suggested that mortality rates might be reduced by 20–50% for a range of procedures including carotid endarterectomy, abdominal aortic aneurysm repair, pancreatectomy and oesophagectomy if carried out by high volume surgical groups [2]. It has been suggested that volume-based referral strategies are most appropriate for operative interventions, which are relatively infrequent, technically complex and with challenging post-operative care [1]. Surgery of the aortic arch would seem to be one area where such considerations might apply because surgical treatment of aortic arch pathology requires partial or complete replacement of the aortic arch while the systemic
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