IJCS | Volume 31, Nº5, September / October 2018

470 Oliveira et al. Mortality and survival in aortic arch surgeries Int J Cardiovasc Sci. 2018;31(5)466-482 Original Article endoprosthesis in descending aorta, time of ECC, aortic cross-clamping time, minimum temperature during hypothermia, nature of surgery: elective, urgent (24 - 72h of symptom onset) or emergent (within 24 hours of symptom onset), cardiorespiratory arrest during anesthetic induction, intraoperative complications, and death in the operating room. Postoperative data evaluated were: clinical progress – low output syndrome (cardiogenic shock), cardiac tamponade, complications – ischemic, mechanical, respiratory, metabolic, neurological (ischemic or hemorrhagic event confirmed by imaging test according to medical records data), cardiologic, infectious and vascular complications, postoperative drainage volume within the first 24 hours, time of hospitalization, time of mechanical ventilation and hospitalization outcomes (death, discharge or transfer to other facilities). Mortality and survival Thirty-day mortality was defined as the total number of deaths that occurred in 30 days after surgery divided by the total number of surgeries performed. Hospital mortality was defined as the total number of in-hospital deaths after surgery divided by the total number of surgeries performed. Cardiovascular deaths were defined by the codes – I00-I99, E10-E14, R57 and J81 according to the International Statistical Classification of Diseases, tenth revision (ICD- 10). Survival was considered as time (in years) after surgery according to data registered by the death registration service (SES-RJ/SVS/CGVS/ADVITAIS). Patient’s anonymity was protected, and patients’ consent for the use of their data for research purposes was sought using a proper form at admission. Confidentiality of the data obtained from the SES-RJ/ SVS/CGVS/ADVITAIS was assured and protected by password (Appendix C and D). Statistical analysis The SPSS software version 21.0 forWindows was used in all analyses. Continuous variables were expressed as mean and standard deviation or median and interquartile range according to normality (or not) of data distribution, tested by the Kolmogorov-Smirnov test. Categorical variables were expressed as percentage. The unpaired Student’s t-test and the Mann-Whitney test were used for analysis of parametric and non-parametric variables, respectively. The chi-square test and Fisher’s exact test were used for comparison of parametric variables. A conventional level of significance was adopted, p < 0.05. Overall survival and cardiovascular event-free survival were assessed by Kaplan-Meier curve and the log-rank test. Results Data of 111 patients who had undergone surgical treatment of aortic arch dissection or aneurysm from 2000 to 2013 were evaluated. Most patients weremen (n = 73, 65.77%) withmean age of 63 ± 13 years in group A and 64 ± 15 years in group B. In the preoperative period, the most frequent risk factors were SAH (90%), DM (37.7%) and obesity (19.7%) in group B. In group A, the same risk factors were observed, with statistical significance for DM (41.7%, p = 0.036). Median preoperative serum creatinine was 0.95 mg/ dL (0.80 - 1.30 mg/dL) in group A and 1.10 mg/dL (0,90 - 1,30 mg/dL) in group B. The incidence of chronic renal failure was 7.7% in group A and 10.8% in group B; 3.9% of these patients were on hemodialysis or peritoneal dialysis. Patients with previous cardiac surgeries were found in group B (and not in group A); 3.9% (3 patients) underwent myocardial revascularization surgery, 6.5% (5 patients) valve replacement and 5.3% (4 patients) partial aortic replacement. No patient had active endocarditis in the preoperative period. In group A, no patient had stable angina or heart failure and in group B, 2.7% of patients had unstable angina and 1.3% had heart failure in the preoperative period (Table 1). Regarding surgical data, mean ECC time was 169 ± 42 minutes in group A and 156 ± 59 minutes in group B (p = 0.311); mean aortic cross-clamping time was 128 ± 44 minutes in group A and 116 ± 41 minutes in group B (p = 0.200). Median minimum temperature achieved during hypothermia induced for aortic arch reconstruction was 26 ± 4ºC in group A and 27 ± 5ºC in group B (p = 0.169). Drainage volume within the first 24 hours of surgery was 468 mL and 375 mL in groups A and B, respectively (p = 0.469). Blood transfusion was commonly required during the procedures (89.3% and 81.1% in groups A and B, respectively) (p = 0.321).