The Clinical Impact of Concomitant Hemi-Arch Reconstruction at the time of Aortic Root Replacement

<h2>Abstract</h2><h3>Objective</h3> The significance of concomitant hemi-arch aortic reconstruction in the setting of aortic root replacement is largely unknown. In this first multi-institutional study, the clinical impact of concomitant hemi-arch aortic reconstruction at the time of aortic root replacement was reviewed. <h3>Methods</h3> From 2004 to 2021, 1869 patients underwent aortic root replacement and ascending aorta replacement at 2 major academic centers: 1116 with concomitant hemi-arch aortic reconstruction (aortic root replacement/hemi-arch aortic reconstruction) and 753 without hemi-arch aortic reconstruction (aortic root replacement/ascending aorta). Procedure and propensity score matching resulted in 698 pairs, which were compared. The primary end point was in-hospital mortality. <h3>Results</h3> Mean age at operation was 56.8 ± 14.7 years and similar between groups (<i>P =</i> .984). Median cardiopulmonary bypass time (<i>P <</i> .001) and aortic crossclamp time (<i>P <</i> .001) were longer for aortic root replacement/hemi-arch aortic reconstruction. Patients receiving aortic root replacement/hemi-arch aortic reconstruction were more likely to need intra-aortic balloon pump support postoperatively (6.3% [44] vs 2.4% [17], <i>P <</i> .001). Permanent neurologic dysfunction occurred in 31 patients (4.5%) undergoing aortic root replacement/hemi-arch aortic reconstruction and 15 patients (2.2%) undergoing aortic root replacement/ascending aorta (<i>P =</i> .02). In-hospital mortality for patients receiving aortic root replacement/hemi-arch aortic reconstruction was 5.0% (35) and 2.6% (18) for patients receiving aortic root replacement/ascending aorta (<i>P =</i> .02). Ten-year survival was 79% versus 74% for hemi-arch aortic reconstruction versus aortic root replacement groups, respectively (<i>P =</i> .06). <h3>Conclusions</h3> Clinical outcomes after both aortic root replacement/ascending aorta or with concomitant hemi-arch aortic reconstruction are excellent. Concomitant hemi-arch aortic reconstruction was associated with a higher rate of postoperative stroke and in-hospital mortality. The decision to perform hemi-arch aortic reconstruction at the time of aortic root replacement should be considered carefully and must be individualized in a patient-specific manner for optimal outcomes.