Introduction
The optimal approach to aortic arch repair in the setting of ascending aortic disease remains controversial and continues to evolve, especially in the setting of acute aortic dissection. While some advocate for replacement of the entire aortic arch during extended replacement of the ascending aorta1-3, others restrict aortic arch repair to those settings in which aortic pathology exists4-6. Proponents of the former approach argue that a more aggressive approach to the aortic arch prevents the need for subsequent reintervention and potentially leads to better long-term outcomes. Others argue that absent aortic arch pathology, total arch replacement is associated with increased morbidity and mortality and may not decrease the need for further aortic reintervention or result in improved long-term survival.
Our custom has been to perform a hemiarch operation whenever possible, as long as it fully addresses the indication for operation. Total arch replacements are reserved for aortic dissections with tears in the arch, or aneurysms and other aortic arch pathology that involve the aortic branches. This study compares our results with hemiarch vs. total arch replacements in 261 consecutive operations for primary ascending aortic pathology with the objective to identify preoperative and operative factors associated with mortality and need for aortic reintervention.