Clinical outcomes of different surgical approaches for proximal descending thoracic aneurysm involving the distal arch

Background: The aim of this study was to evaluate clinical outcomes of different approaches to patients with proximal descending thoracic aneurysm (DTA) involving the distal arch. Methods: From January 2002 to December 2016, 229 consecutive patients with proximal descending aorta aneurysm involving the distal arch underwent surgery using different approaches: total arch and DTA replacement via sternotomy (TAR group; n = 98), hemiarch and DTA replacement via thoracotomy (DTR group; n = 84), or hybrid arch repair (HAR group; n = 47). We retrospectively evaluated the outcomes of the 3 groups with a mean follow-up duration of 60.2 months. Results: The in-hospital mortality rate was 3.1% (3/98) in the TAR group, 11.9% (10/84) in the DTR group, and 4.3% (2/47) in the HAR group (P = .04). The TAR group had a lower incidence of stroke (3.1%, 3/98) compared with the DTR (13.1%, 11/84) and HAR (10.6%, 5/47) groups (P = .03). The overall survival rate at 10 years was 82.8% +/- 5.6% for the TAR group, 61.0% +/- 8.6% for the DTR group, and 55.9% +/- 9.0% for the HAR group (vs DTR [P = .03] and HAR [P<.01]). The freedom from composite of aortic events at 10 years was 75.6% +/- 8.1% in the TAR group, 43.6% +/- 14.9% in the DTR group, and 31.1% +/- 11.5% in the HAR group (P<.01). Conclusions: The sternotomy approach showed better outcomes in terms of operative mortality, stroke, and long-term survival compared with the thoracotomy or hybrid approaches. This study suggests that the sternotomy approach is the superior option for patients with proximal descending aneurysm involving the distal arch.