Outcomes of Total Arch Replacement After Prior Aortic Surgery

In this 32-year, single-center retrospective study, the authors evaluated outcomes of total arch replacement (TAR) after prior aortic surgery. Among 219 patients undergoing reoperative TAR between 1993 and 2025, procedural volume increased more than fourfold over the study period. Early mortality was 5.9 percent and declined significantly from 14.6 percent in 1993–2010 to 3.9 percent in 2011–2025 (p=0.009), while postoperative stroke decreased from 12.2 percent to 4.0 percent (p=0.037). Overall survival was 74.7 percent at five years and 61.3 percent at 10 years. Independent predictors of late mortality included earlier surgery year, older age, moderate or severe obstructive pulmonary disease, renal failure, emergency surgery, and longer circulatory arrest time. The extent of the prior operation and concomitant root surgery were not associated with outcomes. The authors conclude that reoperative TAR has become increasingly common, with substantial improvements in early mortality and stroke over time.