IJCS | Volume 31, Nº5, September / October 2018

476 Oliveira et al. Mortality and survival in aortic arch surgeries Int J Cardiovasc Sci. 2018;31(5)466-482 Original Article However, this result should be interpreted with caution, as these frequencies corresponded to 3 patients in group A and only 1 patient in group B in absolute number due to the small sample size, and maybe these frequencies would not be repeated in larger populations. Diagnosis of AMI was established very subjectively, only by medical records data, without considering electrocardiographic or clinical (cardiac enzymes) criteria. It is also worth pointing out that the lack of difference in the frequency of cardiogenic shock between the groups and the use of BIA reinforce the hypothesis that the frequency of AMI in the postoperative period was not relevant or, if present, not clinically significant. Early mortality in patients with type A aortic dissection varies between 15 and 35% in the literature, with an estimated 5-year survival between 65% and 75%. 20 In our study, 30-day mortality (24.1% in group A and 26.8% in group B) and in-hospital mortality (31.0% in group A and 29.3% in group B) were similar between the groups, with no statistically significant difference. Overall 30-day mortality in a group of 518 patients undergoing type A aortic dissection repair was 20.2%. 21 Martín et al. 15 reported an in-hospital mortality rate of 15% in patients undergoing aortic dissection surgery. In another study comparing partial aortic arch repair with total aortic arch repair, in-hospital mortality rate was 6.7% and 6.9%, respectively. 22 In the study by Dossche et al., 23 including 163 patients, 55% of them with degenerative aneurysm and 28% with acute type A dissection, in-hospital mortality or perioperative neurological complications did not significantly affect the duration of selective antegrade cerebral perfusion. In univariate analysis, some factors had a significant influence on overall mortality – acute type Adissection (p = 0.003), central neurological damage less than 24 h before the surgery (p < 0.001), preoperative hemodynamic instability (p = 0.034), and thoracotomy for any cause (p = 0.036). Patel and Deeb 24 also reported that morbidity increases with the necessity of (total or partial) aortic arch resection, with an increased risk from 5% to 7%. Early mortality in type A aortic dissection is greater than 20%. In addition, repair of thoracoabdominal aortic aneurysm is still recognized as a high-risk procedure, with mortality and paraplegia rates higher than 20%, according Acher & Wynn. 25 Kazui et al. 9 evaluated 330 patients who underwent aortic arch surgery using selective cerebral perfusion. Surgeries were performed with hypothermia, ECC, selective cerebral perfusion and systemic circulatory arrest. Total aortic arch replacement with a branched graft was performed in 288 patients (94%). In-hospital mortality rate was 11.2%. Short- and long-term survival in patients with acute type A aortic dissection varies from 52 - 94% (1 year) and 45 - 88% (5 years). Ten-year survival rate of patients with acute dissection after initial hospitalization was reported to be between 30% and 60% inmany studies. In the study by Shiono et al., 22 a 55% and a 30% survival rate within 10 years and 20 years, respectively were reported. In our study, survival rates were 65.5% and 65,9% within 1 year, 59.3% and 59.0%within 2 years, and 45.5% and 35.8%within 5 years in groups A and B, respectively. These results are in accordance with the review by Braverman, 20 in which a 5-year survival rate of 45 - 88% was described. Our results do not corroborate the hypothesis that a partial aortic arch repair with preservation of part of affected tissue could worsen mortality andmorbidity by increasing the risk for recurrent dissection or aneurysm expansion of remaining tissue. Five-year mortality rate was similar between the groups (45.5% vs. 35.8%). In the meta-analysis by Li et al., 18 comparing partial and total aortic arch repair, 5-year survival rate was also similar between the groups (77.4% vs. 80.8%). In addition, the authors point out that, although the literature does not support superiority of total aortic replacement over partial replacement, a more extensive resection may be necessary in case of extensive lesions, or those located in the aorta. The choice for this method should be individually considered according to clinical and anatomic conditions, as well as pathologic features of the dissection. Considering only deaths for cardiovascular causes, group A was superior than group B, with a 5-year cardiovascularmortality of 22.7%and 50.9%, respectively. These rates demonstrate both safety and efficacy of surgical strategy used in group A for aortic aneurysm and dissection (whenever possible). Conclusions This study showed that cardiovascular mortality was significantly different between the groups after a 5-year follow-up. The group in which a partial preservation of aortic arch and supra-aortic vessels was performed