Analysing the extent of surgery on short and long-term outcomes after planned major aortic surgery

Abstract Objectives Planned proximal thoracic aortic replacement is a safe and routinely performed contemporary cardiac surgical intervention. It remains unclear whether the addition of proximal (aortic root) and/or distal (aortic arch) aortic replacement confers short-term risk or long-term benefit in patients undergoing planned aortic surgery. Methods Single-centre retrospective review of all patients undergoing first-time non-emergency proximal thoracic aortic replacement in a tertiary UK cardiac surgery centre between 1997 and 2025. Patients were divided into four groups: isolated ascending aorta replacement, proximal extension (aortic root replacement), distal extension (aortic arch replacement [including hemi-arch, partial and total arch replacement]) and combined extension (including proximal and distal extension). Primary outcomes were in-hospital mortality and overall survival. Secondary outcomes were stroke, blood transfusion and post-operative length of stay (PLOS). Univariable analysis was used to compare outcomes between groups. Multivariable regression was used to identify factors independently associated with in-hospital mortality and overall survival. Results 491 patients were included (44.8% isolated ascending, 14.5% proximal extension, 31.4% distal extension, 9.4% combined). Overall in-hospital mortality was 2.6% (n = 13). Combined extension was independently associated with in-hospital mortality on multivariable analysis (odds ratio 8.220, 95% confidence intervals 1.738-38.881, p = 0.008). Multivariable survival analysis did not demonstrate any independent association between long-term outcomes and extent of intervention. Conclusions Planned major aortic surgery carries low rates of mortality and morbidity in the contemporary era. More extensive aortic intervention can be safely performed on appropriately selected patients with limited impact on short-term outcomes and no apparent effect on overall survival.