Assessing Cardiovascular Surgical Outcomes in Hemiarch, Total Arch, & Zone 2 Aortic Replacements: A Single-Center Experience
Name: Adedeji Adeniyi
School: Vagelos College of Physicians and Surgeons, Class of 2023
Mentors: Hiroo Takayama, MD, PhD and Anette Wu, MD, MPH, PhD
Abstract
Our research was a single-center retrospective comparison of baseline characteristics, intraoperative factors, and short-term outcomes in three treatment groups --hemiarch, zone 2, and total arch replacements-- to investigate the effect of zone 2 repair on postoperative outcomes. Traditionally, aortic arch reconstructions typically involved either distal repairs by hemiarch anastomosis or a more aggressive approach of including the total arch. However, considering an acquired experience with total arch replacement, our institution began increasingly targeting the zone 2 landing strip. Zone 2 surgical interventions offers advantages including (1) phased out usage of “U” shaped stent grafts, (2) reduced complexity due to proximal anastomosis without need of sewing to the descending aorta, (3) greater avoidance of injury to the left recurrent laryngeal nerve, and lastly (4) the robust landing zone offered for subsequent thoracic endovascular aortic repair (TEVAR) (Appoo et al.). Our research included 784 patients, 18 years or older, who underwent hemiarch, total arch, and zone 2 arch repairs between July 2005 through December 2019. Preliminary unadjusted pairwise comparison of hemiarch and total arch suggests worse short-term outcomes as defined by increased levels of in-hospital complications and a longer length of stay. No significant difference was found for pairwise comparison of hemiarch v. zone 2 or total arch v. zone 2. Statistical analysis is ongoing to address limitations including a reduced zone 2 cohort (43 patients) and to account for potential bias due to the retrospective nature of the study and will be available at time of presentation.
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