Outcomes of Total Aortic Arch Replacement in a Canadian Nationwide Registry

Accurate benchmarking of outcomes following elective open total arch replacement is important for surgical decision-making and for comparisons to emerging endovascular technologies.A multicenter registry of consecutive aortic arch procedures in 9 centers across Canada contained 250 elective total arch replacements from 2010 to 2021. A total of 728 patients undergoing elective hemiarch replacement over the same time period was used as a comparator group. Propensity score matching was used to construct 202 well-matched pairs.Patients undergoing total arch replacement were 63.2 ± 13.6 years old; 34% were female. These patients were more likely to have connective tissue disorders compared to patients undergoing hemiarch replacement. When under hypothermic circulatory arrest, the total arch group uniformly used antegrade cerebral perfusion with a nadir median temperature of 24 (IQR 21-25)°C, and duration 33 (IQR 23-51) minutes. Before matching, in-hospital mortality and stroke rates were 5.2% and 10% for the total arch group, respectively. After matching, the total arch group had similar in-hospital mortality with the hemiarch group (p=0.58). Rates of stroke were also not statistically different (p=0.11). The total arch group was more likely to experience delirium, prolonged intubation, increased intensive care unit length of stay and transfusions.Elective total arch replacement is performed with good in-hospital mortality rates that are comparable to rates after elective hemiarch repairs. However, total arch replacement was associated with significantly higher rates of other morbidities including delirium and prolonged intubation.