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Outcomes of Open vs. Closed Distal Anastomosis in Ascending Aortic Reconstruction

This study evaluates the outcomes of elective ascending aortic reconstruction using open distal anastomosis with retrograde cerebral perfusion (RCP) compared to closed distal anastomosis with aortic cross-clamping. An analysis of 687 patients was conducted, focusing on endpoints such as stroke, temporary neurologic deficit, ventilator hours, ICU stay, and length of hospital stay. The findings indicate no significant differences in 30-day or intermediate-term mortality and suggest that open distal reconstruction should be routinely considered for ascending aorta repairs.

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Outcomes of Open vs. Closed Distal Anastomosis in Ascending Aortic Reconstruction

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  1. Routine Hypothermia with Circulatory Arrest and Retrograde Cerebral Perfusion for Ascending Aortic Reconstruction Division of Cardiac SurgeryBrigham and Women’s Hospital Andrew W. ElBardissi, MD, MPH Sary F. Aranki, MD Lawrence H. Cohn, MD Stanton K. Shernan, MD Daniel J. FitzGerald, CCP, LP R. Morton Bolman III, MD Aortic Symposium 2010

  2. Natural History of Aneurysmal Disease

  3. Background • Aneurysmal ascending aortic degeneration includes aortic tissue proximal to the innominate artery • Aortic cross-clamping leaves a segment of aneurysmal distal ascending aorta

  4. Surgical Result following Reconstruction Open Distal Anastomosis Closed Distal Anastomosis

  5. Objective • Evaluate outcomes of elective ascending aortic reconstruction with open distal anastomosis (with RCP) versus closed distal anastomosis with aortic cross-clamping.

  6. Methods 687 patients with Ascending Aortic Reconstruction (2005-Present) Aortic Dissections Complex aortic arch reconstructions 305 patients 110 open distal (OD) anastomosis with RCP 195 closed distal (CD) anastomosis 1:1 Propensity Matching 99 CD 99 OD

  7. Methods • Primary endpoint • CVA • Temporary Neurologic Deficit • Ventilator Hours • ICU Hours • Length of Stay • Secondary endpoint • 30-day mortality • Intermediate-term Survival

  8. Preoperative Characteristics

  9. Operative Characteristics

  10. 1.00 0.95 0.90 0.85 0.80 0.75 0.70 0.65 0.60 0.55 0.50 0.00 300 900 1200 Follow-up (days) Results P=0.44 P=0.42 P=0.57 P=0.20 P=0.52 n=2 n=1 n=2 P=0.30 No difference in 30 day (OD, 0% vs. CD, 1%, p=0.59) or Intermediate-term Mortality

  11. Conclusions • Open distal reconstruction of ascending aorta in AAA repair • No difference in operative mortality, stroke, temporary neurologic deficit, ventilator hours, ICU hours, or LOS compared to closed distal with aortic x-clamping • Should be considered as a routine treatment strategy, as it allows removal of AA in its entirety

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