IJCS | Volume 31, Nº5, September / October 2018

DOI: 10.5935/2359-4802.20180069 466 ORIGINAL ARTICLE International Journal of Cardiovascular Sciences. 2018;31(5)466-482 Mailing Address: Paula Ferraz de Oliveira Rua Almirante Baltazar, 131, apto 303. Postal Code: 20941-150. São Cristóvão, Rio de Janeiro - RJ - Brazil. E-mail: ferrazpaulade@gmail.com Mortality and Survival in Aortic Arch Surgeries with Preservation of Supra-aortic Vessels: Thirteen Years of Experience Paula Ferraz de Oliveira, 1,2 Gustavo Luiz Gouvêa de Almeida Junior, 1,2 Fabrício Braga da Silva, 1,2 Mauro Paes Leme de Sá, 3 Valdo José Carreira, 1 Bruno Soares da Silva Rangel, 1,3 Sicilia Pacheco e Silva 1 Casa de Saúde São José, 1 Rio de Janeiro, RJ - Brazil Instituto de Cardiologia Edson Saad da Universidade Federal do Rio de Janeiro, 2 Rio de Janeiro, RJ - Brazil Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro (UFRJ), 3 Rio de Janeiro, RJ - Brazil Manuscript received June 12, 2017, revised manuscript October 21, 2017, accepted December 19, 2017. Abstract Background: The aortic arch diseases exhibit high morbidity and mortality rates. Some surgical strategies recommend partial preservation of the aortic arch and the supra-aortic vessels, but the immediate and medium- term mortality rates of patients undergoing this surgical strategy is uncertain. Objectives: To compare overall mortality and mid- term survival curve of patients undergoing surgical strategy of partial preservation of the aortic arch and supra-aortic vessels (group A) compared to conventional strategies of the aortic arch approach (group B); to assess cardiovascular mortality over time. Methods: Descriptive and retrospective study of the medical records of patients undergoing aortic arch repair surgery between February 2000 and July 2013. We analyzed 111 patients, 29 in group A and 82 in group B. The overall survival and survival from cardiovascular events were assessed by Kaplan-Meier test. Results: In- hospital mortality from any cause was 31% in group A and 29.3% in group B. At 1 year, 2 year, and 5 year general survival was similar between the groups. In-hospital, 2 years and 5 years mortality from cardiovascular causes was 13.8%, 14.8%, e 22.7% in group A and 26.8%, 34.6% e 50.9% in group B. The difference between the groups in 5 years showed statistical significance (p = 0.0234). Survival from cardiovascular causes in 2 years and 5 years was 85.2% and 77,3% in group A and 65.4% and 49,1% in group B. Occurrence of urgent and emergency procedures were greater in group A, but without statistical significance. Conclusions: There was no difference in all-cause mortality over time between the groups. Group A showed lower cardiovascular mortality at 5 years than group B. (Int J Cardiovasc Sci. 2018;31(5)466-482) Keywords: Aorta, Thoracic / physiopathology; Aorta, Thoracic / surgery; Mortality; Aortic Aneurysm / surgery; Survivorship (Public Health); Comparative Study. Introduction Despite considerable advances in diagnostic methods, surgical techniques (percutaneous or open surgical techniques) andpostoperative care, thoracic aortic diseases, and especially aortic arch diseases are still major causes of cardiovascular mortality and challenge for physicians. 1 The Global Burden of Disease Study 2010 showed that overall mortality rate for aortic aneurysm and aortic dissection increased from 2.49 per 100,000 population in 1990 to 2.78 per 100,000 population in 2010, with higher rates among men. 2,3 The timing of surgical interventions in themanagement of thoracic aortic diseases considers the risk of rupture, possible postoperative complications and patients’ life expectancy. Natural progression of thoracic aortic diseases is directly related to the aortic segment involved and the cause of the disease. 4 Surgical management of the aortic arch is considered a complex approach, because of the high risk of brain