IJCS | Volume 31, Nº5, September / October 2018

468 Oliveira et al. Mortality and survival in aortic arch surgeries Int J Cardiovasc Sci. 2018;31(5)466-482 Original Article A vascular prosthesis is then anastomosed to the (valved or not) Dacron aortic graft by continuous suture technique using 5.0 polypropylene. The cannula placed into the brachiocephalic trunk is removed, and perfusion is maintained only through the cannula placed in the aortic prosthesis. Rewarming continue until nasopharyngeal temperature of 36ºC. Distal and proximal aortic anastomoses can be performed with separate prostheses by anastomosis of proximal to distal aortic grafts. Conventional surgical strategies for aortic arch approach (Group B) In severe atherosclerotic disease and brachiocephalic trunk dissection, the surgical strategy of partial preservation of aortic arch and supra-aortic vessels cannot be performed, andmany other procedures can be performed as alternative. Despite the differences between them, these techniques share common features. Group B comprised different techniques, previously described by other authors, that included moderate hypothermia combined with antegrade cerebral flow, or profound hypothermia combined with brief circulatory arrest. Complete circulatory arrest for up to 15 minutes and temperature decrease to up to 25ºC is considered safe, with no risk of neurologic sequelae. Periods from 15 to 30 minutes, and periods of up to 40 minutes or up to 60 minutes of complete circulatory arrest seem to be associated with transient neurological dysfunction in nearly 10%, 15% or even 60% of patients, respectively. In the first technique, described by a group from Mount Sinai Hospital, NY,10 the aortic convexity and cerebral vessels (not affected by dissection of atherosclerotic disease) are dissected en bloc and sutured to a 14 - 16 mm Dacron graft for posterior anastomosis to a second larger Dacron graft, placed between ascending and descending segment of thoracic aorta, resulting in the aortic arch reconstruction. Similarities with the technique described in Group A include prolonged periods of antegrade cerebral perfusion, and treatment of the aortic stump alone, which may include the insertion of an endoprosthesis in the descending aorta, as in type I aortic dissection. Another technique for aortic arch disease involves the use of antegrade cerebral perfusion through catheterization of cerebral vessels, brachiocephalic trunk and left carotid artery or only profound hypothermia. In this case, cerebral vessels are also dissected en bloc (aortic convexity and brachiocephalic trunk, left carotid and left subclavian artery) and anastomosed to the interposed Dacron graft, substitute for the aortic arch. 11 In a more recent technique, developed after the advent of branched Dacron grafts, the separated graft technique substitutes the en bloc repair technique for aortic arch reconstruction. A graft with four limbs is used, 3 of them in the arch of the graft and 1 used for reestablishment of ECC. Antegrade cerebral perfusion may also be used in this technique, as described by Kazui et al. 12 in 2000 with a catheter placed in the brachiocephalic trunk and left carotid artery. Objectives I. Primary objective To evaluate medium-term (5 years) mortality and survival rates in patients undergoing the surgical technique of partial preservation of aortic arch and supra- aortic vessels in comparisonwith conventional strategies for aortic arch reconstruction. II. Secondary objective To evaluate 30-day, 1 year, 2-year, 5-year cardiovascular mortality. Methods Study population In this retrospective study, we evaluated medical records of patients hospitalized for surgical resection and/or surgical treatment of aortic arch aneurysm in hospitals in Rio de Janeiro. The initial sample was composed of 150 patients, and data of 111 patients operated fromFebruary 2000 to July 2013 were analyzed. All patients underwent surgical repair of aortic arch and ascending aorta diseases performed by the same surgical staff. Of the 111 patients included, 29 underwent the strategy with partial preservation of aortic arch and supra-aortic vessels (Group A) and 82 underwent conventional surgical techniques for aortic arch reconstruction (Group B) (Figure 1). The search for medical records was conducted by the medical records department of each institution. A standardized form (Appendix A) was used for collection of clinical and surgical data of patients.