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Background: The aim of this study was to determine perioperative factors influencing neurologic outcome in a single-center cohort of patients undergoing elective aortic arch operations., Methods: From January 2005 to June 2015, 791 consecutive patients received open aortic arch operations with either antegrade selective cerebral perfusion (ASCP) (636 patients [80.4%]) or deep hypothermic circulatory arrest (DHCA) (155 patients [19.6%]). Main indications were degenerative aneurysm (85%) and chronic postdissection aneurysm (9.1%)., Results: Hospital mortality (30 days) was 5.3%. Permanent neurologic dysfunction (PND) was observed in 42 patients (5.3%). Significant risk factors for PND appeared to be femoral artery cannulation (p = 0.003), progressive cardiopulmonary bypass (p = 0.001), circulatory arrest (p = 0.001), and ASCP time (p = 0.011). ASCP, in contrast to DHCA, was protective against PND (odds ratio [OR], 0.37; p = 0.003). Temporary neurologic dysfunction (TND) was observed in 49 patients (6.2%). Preoperative transient ischemic attack (TIA) (p = 0.001), progressive EuroSCORE (p = 0.001), left ventricular ejection fraction (LVEF) less than 50% (p = 0.003), and the use of femoral artery cannulation (p = 0.049) showed correlation in the univariate analysis. Stepwise logistic regression indicated TIA (p = 0.002; OR, 3.24) and the EuroSCORE (p = 0.003; OR, 1.23) as independent predictors of TND., Conclusions: Contemporary elective aortic arch repair can be achieved with low mortality and a low incidence of neurologic dysfunction. ASCP was confirmed to be the safest method of cerebral protection. The extent of aortic arch replacement (apart from the frozen elephant trunk [FET] procedure) was not related to increased rates of TND or PND., (Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Objectives: In this study, a propensity-matching analysis was used to compare biological versus mechanical composite valve graft implantation for early mortality and morbidities and for late complications including the need for aortic reintervention., Methods: Between 1978 and 2011, 1112 consecutive patients underwent a complete aortic root replacement using either a biological Bentall (BB, n  = 356) or a mechanical Bentall (MB, n  = 756) valve conduit. Preoperative data were stratified according to the type of valve graft, and treatment bias was addressed by propensity score analysis., Results: Two homogeneous groups of 138 patients were obtained. Hospital mortality between them was comparable (MB = 7.2% and BB = 5.8%, P  = 0.6). They also had similar results after a mean follow-up time of 40 ± 38 months. Propensity-adjusted Cox-regression analysis showed no relationship between the type of prosthesis and all-cause mortality at follow-up (hazards ratio: 0.88; 95% confidence interval: 0.50-2.14; P  = 0.4). Freedom from proximal aortic reintervention at 1, 5 and 7 years was 99.1 ± 0.9% in the MB group compared with 98.4 ± 1.1%, 93.0 ± 3.2% and 93.0 ± 3.2% in the BB group (long-rank P  = 0.07)., Conclusions: The Bentall procedure is a safe and reproducible treatment for ascending aorta pathologies. The choice of either a mechanical or a biological valve graft seems to have no influence on early and late midterm adverse outcomes including need for aortic reinterventions., (© The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

Background: Aortic dissection is a major cardiovascular disease associated with a high mortality rate. In complicated type B dissection, with favorable anatomy, endovascular surgical repair (thoracic endovascular aortic repair [TEVAR]) is considered the treatment of choice. Intimomedial injury induced by stent graft, or stent graft-induced new entry (SINE), has a clinically significant incidence. SINE can occur at the proximal or distal level of the stent graft. The aim of this retrospective study was to investigate the incidence, mechanism, and predictive factors of late distal SINE., Methods: We reviewed 139 discharged patients after TEVAR for type B or residual aortic dissection after type A surgery, from January 2007 to March 2013. Three intervals of computed tomography imaging were collected, including before and after primary TEVAR and with the first detection of distal SINE. Four accessible measurement methods for precise size selection of the stent graft before and after the procedure were analyzed at the distal end level of the primary stent graft., Results: Among the 139 patients, only 108 had complete preoperative and follow-up imaging and were enrolled in the study. The mean age of the patients was 59.7 ± 11.7 years, and 92 patients (85.2%) were men. Seventy had type B aortic dissection, and 38 had residual aortic dissection after type A surgery. The mean follow-up period was 36.1 ± 25.7 months. During follow-up, distal SINE occurred in 30 patients (27.8%), and 18 of them (60%) underwent secondary TEVAR whereas the remaining 12 patients were medically treated. No statistically significant differences in demographic and clinical conditions were seen between patients with or patients without SINE. The incidence of SINE was lower for acute than for chronic dissection (16% versus 50%). At the multivariate analysis, the independent factors associated with SINE development were the oversizing ratio of the area (odds ratio 1.858; 95% confidence interval: 1.109 to 3.064; p = 0.018) and of the mean diameter (odds ratio 1.858; 95% confidence interval: 1.109 to 3.064; p = 0.018)., Conclusions: Type B aortic dissection can be treated effectively with TEVAR. The incidence of distal SINE is not negligible but is not associated with poor outcomes. The main determinant of SINE seems to be an excessive oversizing, which is particularly evident in the distal end. More accurate sizing can be obtained by evaluating the area of the true lumen., (Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)