Long-term outcomes of total arch replacement using a 4-branched graft

Objective: Our study evaluated the long-term outcomes of total arch replacement using a 4-branched graft. Methods: From October 1999 to December 2016, 655 patients underwent total arch replacement using a 4-branched graft (pathology in the 655 patients was distributed as 399 no dissection, 149 acute dissection, and 107 chronic dissection). Two hundred nine patients (31.9%) underwent nonelective surgery. Mean followup term was 5.0 +/- 4.1 years and follow-up rate was 97.1%. Results: Of 655 patients who underwent total arch replacement using a 4-branched graft, operative mortality occurred in 34 patients (5.2%) and permanent neurologic deficit occurred in 24 patients (3.7%). One hundred ninety late deaths occurred, with 20 aortic event-related deaths. Overall survival was 73.1% +/- 1.9% at 5 years and 54.8% +/- 2.7% at 10 years. Multivariate Cox-hazard regression analysis demonstrated that older age, lower estimated glomerular filtration rate, concurrent procedures, permanent neurologic deficit, tracheostomy, and renal failure were significant risk factors for late death. Freedom from repeat operation on the aorta was 98.0% +/- 0.7% at 5 years and 93.9% +/- 1.8% at 10 years and freedom from additional aortic operation was 87.2% +/- 1.5% at 5 years and 77.3% +/- 2.7% at 10 years. The incidence of pseudoaneursym was 2.2%. Conclusions: The long-term outcomes for patients undergoing total arch replacement using 4-branched graft are favorable. However, even in the late phase, periodic follow-up is necessary to address subsequent aorta-related events.