Is more aggressive resection of the aorta for ascending aortic aneurysm safe and effective when compared to a less aggresive surgical approach?

One hundred and fifty-one patients underwent elective ascending aortic replacement only for nonsyndromic aneurismal disease between January 2008 to December 2018 were retrospectively reviewed. All data were prospectively collected and recorded. All surgeries were performed concurrently in the same time period. Surgeons who performed these operations were experienced with both circulatory arrest and clamped aortic anastomoses The decision to perform an ascending aortic replacement or a hemiarch replacement was at the discretion of the surgeon. Description of the procedures: Surgical access was obtained through a median sternotomy. Hemiarch repair was conducted under cardiopulmonary bypass (CPB) and MHCA with unilateral ACP via innominate artery with a flow rate of 8–10 ml/kg/min and perfusion pressure of 60–80 mmHg. Perfusion adequacy was evaluated using measurement of blood pressure in both radial arteries and cerebral oximetry using near-infrared spectroscopy. Once CPB was instituted, the aortic cross-clamp was applied, and the heart was arrested with antegrade cardioplegia. After gradual cooling and when rectal temperature was approximately 28 degrees C, the circulatory arrest was initiated. Hemiarch replacement involved resection lesser curve of the aortic arch from the base of the innominate artery (Zone 0) to a point immediately distal to the nadir of the lesser curvature (Zone 3 or Zone 2 if the left subclavian artery was too far). Ascending aortic replacement was performed under normothermia with an aortic cross-clamp at the base of the innominate artery. Audit of nurse notes (arterial pressure in both radial arteries, NIRS, body temperature), perfusion records (perfusion rate and perfusion pressure during both of cardiopulmonary bypass and unilateral cerebral perfusion in Hemiarch procedure, blood temperature, haemohydrobalance), blood tests (acid-base indices, total and biochemical blood tests) were performed to assess or monitor fidelity to the surgery. Mean duration of non-hemiarch and hemiarch repairs surgery is 300 and 370 min, respectively. Mean duration of the circulatory arrest and antegrade cerebral perfusion in the hemiarch group was 15 minutes. Follow-up information was collected using direct or phone contact with patients, relatives, or physicians. All survived patients underwent a clinical follow-up examination and aortic evaluation by CT scan before discharge, at 6 and 12 months postoperatively, and annually thereafter. The median (1st–3rd quartile) duration of the follow-up period was 36 months (12–48 months). The follow-up time was calculated using the date of the most recent CT scan