Proposed Topic (Most preferred): :
Research and Innovations (new projects / technology / innovations / service models)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service II (Projects aiming to enhance clinical safety and outcomes, clinical governance / risk management)
Authors (including presenting author) :
Ng HL, Fujikawa T, Kwok WT, Wan S, Ho YK, Chow CY, Chan WY, Lim K, Chang TC, Siu CH, Wong HL
Affiliation :
Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital
Introduction :
Total arch replacement (TAR) is a gold standard treatment of aortic arch pathologies, including aneurysms and dissections, which is correlated with high mortality and neurological morbidity rates. In the last decade, we have developed and standardized TAR, introducing frozen elephant trunk (FET) technique since 2014. And it enabled us to approach to the extensive aortic pathology involving the arch and descending thoracic aorta safely.
Objectives :
To examine the operative outcomes and advancements of patients undergoing TAR over a 10-year-observation period, in terms of the incidences of mortality and morbidity.
Methodology :
A retrospective study was conducted for 128 patients who underwent TAR between 2013 and 2022. The patient was divided to two cohorts. The first cohort comprised 46 patients treated between January 2013 and December 2017, while the second cohort included 82 patients treated between January 2018 and December 2022. Data on patient demographics, preoperative risk factors, procedural details, and postoperative outcomes were collected and compared between the two cohorts.
Result & Outcome :
The use of the FET technique in TAR patients in terms of procedural advancements was 62.5% (80/128), without significant differences between the two cohorts (63.0% vs. 62.2%) (p = 0.924). Risk factors for mortalities or major complications that were statistically similar: i) Emergency operation (58.7% vs. 50.0%) (p = 0.344) and ii) Mean logistic EuroSCORE (21.8% vs. 23.5%) (p = 0.528), while the median age as one of the risk factors differed statistically significantly between the cohorts (59 vs. 63) (p = 0.07). The overall in-hospital mortality rate was 10.9% (14/128), with modest improvements between the two cohorts (13.0% vs. 9.8%; p = 0.567), however without statistical significance. In non-elective cases, the in-hospital mortality rate was 13.2% (9/68), with pronounced improvements between the two cohorts (18.5% vs. 9.8%; p = 0.466). A notable improvement in five-year survival probabilities was seen without significant differences between the cohorts (48.5% vs 67.2%; Log-rank test p = 0.213; Hazard Ratio = 0.635). The need for re-operation for bleeding or tamponade was 28.9% (37/128), with statistically significant improvements between the two cohorts (41.3% vs. 22.0%; p = 0.02). The incidence of post-operative stroke (8.7% vs. 6.1%; p = 0.721) and new post-operative haemofiltration or dialysis (13.0% vs. 4.9%; p = 0.166) was significantly higher in the first cohort, showing a moderate improvement between the two cohorts. To conclude, the rise in the long-term survival rates in the second cohort reveals improved outcomes in total arch replacement over time. However, further research is needed to identify specific factors contributing to these improvements and explore advancements in TAR techniques. This study highlights the importance of continuous evaluation and refinement of surgical techniques to enhance patient outcomes in TAR.
