Comparable outcomes with reoperative versus primary total arch replacement

PURPOSE: Resternotomy during total arch replacement surgery is associated with adverse outcomes. We aimed to determine the accuracy of this statement. METHODS: From January 2008 to February 2021, 384 consecutive total arch replacement surgeries were performed at our institution. Resternotomy was performed in 53 (14%) patients. We compared the operative outcomes between the first sternotomy and resternotomy groups. RESULTS: The resternotomy group was younger, with a higher mean EuroSCORE II and higher prevalence of Marfan syndrome and chronic dissection. The median durations of operation, cardiopulmonary bypass, coronary ischemic time, selective antegrade cerebral perfusion, and circulatory arrest were significantly longer in the resternotomy group. The in-hospital mortality rate was similar between the two groups (P= 0.50). According to a multivariable analysis, cardiopulmonary bypass time (P< 0.001), female sex (P= 0.01) and emergency status (P< 0.001) emerged as independent predictors of in-hospital mortality, whereas resternotomy did not. A Kaplan-Meier analysis showed no difference in long-term survival between the two groups (Log-rank P= 0.30). CONCLUSIONS: Total arch replacement requiring resternotomy is often technically complex. Nevertheless, appropriate surgical strategies have achieved outcomes as good as those of first sternotomy.