Open aortic arch reconstruction.

Aortic arch reconstruction remains a formidable operative procedure. Pioneering work by DeBakey et al. in 1957 identified neurological complications as a predominant cause of high mortality rate (1). The introduction of deep hypothermic circulatory arrest (HCA) by Griepp et al. simplified the operative approach and established a safe strategy for neuroprotection (2). Seminal work by Crawford and associates demonstrated that these techniques could result in death and stroke rates of 10% and 7% respectively (3). Given the emerging role of thoracic aortic endovascular repair (TEVAR) and its encroachment into the arch segment, we initiated an evaluation of open arch reconstruction to identify the important risk factors for poor outcomes, and define its late results (4).