2018
Management of Patients With Coronary Artery Malperfusion Secondary to Type A Aortic Dissection
Kreibich M, Bavaria JE, Branchetti E, Brown CR, Chen Z, Khurshan F, Siki M, Vallabhajosyula P, Szeto WY, Desai ND. Management of Patients With Coronary Artery Malperfusion Secondary to Type A Aortic Dissection. The Annals Of Thoracic Surgery 2018, 107: 1174-1180. PMID: 30444990, DOI: 10.1016/j.athoracsur.2018.09.065.Peer-Reviewed Original ResearchMeSH KeywordsAgedAortic Aneurysm, ThoracicAortic DissectionBlood Vessel Prosthesis ImplantationCohort StudiesCoronary Artery BypassCoronary Artery DiseaseCoronary CirculationFemaleGermanyHeart Arrest, InducedHospital MortalityHospitals, UniversityHumansKaplan-Meier EstimateLength of StayMaleMiddle AgedPostoperative ComplicationsPrognosisRetrospective StudiesRisk AssessmentStatistics, NonparametricSurvival AnalysisTreatment OutcomeConceptsCoronary artery malperfusionType B patientsType C patientsAntegrade cardioplegiaC patientsB patientsAortic dissectionCoronary ostiumDissection flapCA diseaseA Aortic DissectionType C lesionsManagement of patientsType B lesionsLong-term survivalCA bypassBypass GraftingPerioperative mortalityC lesionsComplete avulsionB lesionsLandmark analysisMalperfusionSuture repairPatientsOutcome After Operation for Aortic Dissection Type A in Morbidly Obese Patients
Kreibich M, Rylski B, Bavaria JE, Branchetti E, Dohle D, Moeller P, Vallabhajosyula P, Szeto WY, Desai ND. Outcome After Operation for Aortic Dissection Type A in Morbidly Obese Patients. The Annals Of Thoracic Surgery 2018, 106: 491-497. PMID: 29673638, DOI: 10.1016/j.athoracsur.2018.03.035.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedAortic AneurysmAortic DissectionBody Mass IndexBody WeightCohort StudiesComorbidityFemaleHospital MortalityHumansLogistic ModelsMaleMiddle AgedObesity, MorbidOdds RatioPostoperative ComplicationsPrognosisReference ValuesRetrospective StudiesRisk AssessmentSurvival AnalysisTreatment OutcomeConceptsAortic dissection type AMorbidly obese patientsNormal weight patientsObese patientsSurgical repairWeight patientsDistal aortic repairImmediate surgical approachMore obese patientsCalculated blood volumeBody mass indexIntensive care unitLength of stayType AHospital mortalityHospital stayPostoperative complicationsAortic repairPostoperative outcomesCare unitClinical featuresClinical presentationMass indexNormal weightAdverse outcomes
2017
Conscious Sedation Versus General Anesthesia for Transcatheter Aortic Valve Replacement
Hyman MC, Vemulapalli S, Szeto WY, Stebbins A, Patel PA, Matsouaka RA, Herrmann HC, Anwaruddin S, Kobayashi T, Desai ND, Vallabhajosyula P, McCarthy FH, Li R, Bavaria JE, Giri J. Conscious Sedation Versus General Anesthesia for Transcatheter Aortic Valve Replacement. Circulation 2017, 136: 2132-2140. PMID: 28864443, DOI: 10.1161/circulationaha.116.026656.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overAnesthesia, GeneralAortic Valve StenosisComparative Effectiveness ResearchConscious SedationFemaleHospital MortalityHumansIntention to Treat AnalysisLength of StayMalePatient DischargePractice Patterns, Physicians'RegistriesRisk AssessmentRisk FactorsTime FactorsTranscatheter Aortic Valve ReplacementTreatment OutcomeUnited StatesConceptsTranscatheter aortic valve replacementAortic valve replacementConscious sedationIntensive care unitGeneral anesthesiaHospital lengthValve replacementProcedural successCare unitEnd-point analysisPercutaneous transfemoral transcatheter aortic valve replacementConscious Sedation Versus General AnesthesiaTransfemoral transcatheter aortic valve replacementCardiology Transcatheter Valve Therapy RegistryThoracic Surgeons/American CollegeDeath/stroke ratePacemaker/defibrillator implantationTranscatheter Valve Therapy RegistryInverse probabilityConscious sedation groupDeath/strokeTreatment-weighted adjustmentTreatment-weighted analysisLower procedural successComparative effectiveness analysisOutcomes of Elective Aortic Hemiarch Reconstruction for Aneurysmal Disease in the Elderly
Kilic A, Arnaoutakis GJ, Bavaria JE, Sultan I, Desai ND, Vallabhajosyula P, Williams ML, Milewski RK, Szeto WY. Outcomes of Elective Aortic Hemiarch Reconstruction for Aneurysmal Disease in the Elderly. The Annals Of Thoracic Surgery 2017, 104: 1522-1530. PMID: 28648536, DOI: 10.1016/j.athoracsur.2017.03.067.Peer-Reviewed Original ResearchMeSH KeywordsAge FactorsAgedAged, 80 and overAorta, ThoracicAortic Aneurysm, ThoracicBlood Vessel Prosthesis ImplantationCirculatory Arrest, Deep Hypothermia InducedCohort StudiesElective Surgical ProceduresFemaleGeriatric AssessmentHospital MortalityHumansMaleMiddle AgedPlastic Surgery ProceduresPostoperative CarePostoperative ComplicationsPrognosisPropensity ScoreRegistriesRetrospective StudiesRisk AssessmentSex FactorsSurvival AnalysisTreatment OutcomeConceptsModerate hypothermic circulatory arrestAntegrade cerebral perfusionHypothermic circulatory arrestHemiarch reconstructionElderly patientsAneurysmal diseaseOperative mortalityCerebral perfusionCirculatory arrestConcomitant aortic valve replacementRisk-adjusted operative mortalityCoronary artery bypassOperative mortality rateAortic valve replacementGreater comorbidity burdenLow operative mortalityOverall stroke rateSafe strategyIntensive care unitComorbidity burdenArtery bypassHospital stayRoot replacementValve replacementCare unit
2016
The Impact of Deep Versus Moderate Hypothermia on Postoperative Kidney Function After Elective Aortic Hemiarch Repair
Arnaoutakis GJ, Vallabhajosyula P, Bavaria JE, Sultan I, Siki M, Naidu S, Milewski RK, Williams ML, Hargrove WC, Desai ND, Szeto WY. The Impact of Deep Versus Moderate Hypothermia on Postoperative Kidney Function After Elective Aortic Hemiarch Repair. The Annals Of Thoracic Surgery 2016, 102: 1313-1321. PMID: 27318775, DOI: 10.1016/j.athoracsur.2016.04.007.Peer-Reviewed Original ResearchMeSH KeywordsAcute Kidney InjuryAgedAorta, ThoracicAortic Aneurysm, ThoracicCause of DeathCerebrovascular CirculationCirculatory Arrest, Deep Hypothermia InducedCohort StudiesDatabases, FactualElective Surgical ProceduresFemaleFollow-Up StudiesGlomerular Filtration RateHospital MortalityHumansHypothermia, InducedLogistic ModelsMaleMiddle AgedMultivariate AnalysisPerfusionPostoperative ComplicationsRetrospective StudiesSurvival AnalysisTreatment OutcomeConceptsAntegrade cerebral perfusionRetrograde cerebral perfusionAcute kidney injuryModerate hypothermic circulatory arrestDeep hypothermic circulatory arrestHypothermic circulatory arrestGlomerular filtration rateHemiarch repairCerebral perfusionCirculatory arrestEjection fractionAneurysmal diseaseLower baseline glomerular filtration rateOccurrence of AKIAortic cross-clamp timeBaseline glomerular filtration rateHigher acute kidney injuryLonger cardiopulmonary bypass timeLow preoperative ejection fractionPostoperative acute kidney injuryAortic hemiarch replacementBaseline renal dysfunctionCerebral perfusion strategyCerebral protection strategiesDistal organ protectionAt the Root of the Repair Debate: Outcomes After Elective Aortic Root Replacements for Aortic Insufficiency With Aneurysm
McCarthy FH, Bavaria JE, McDermott KM, Moeller P, Spragan D, Hoedt A, Dibble T, Savino D, Williams ML, Vallabhajosyula P, Szeto WY, Desai ND. At the Root of the Repair Debate: Outcomes After Elective Aortic Root Replacements for Aortic Insufficiency With Aneurysm. The Annals Of Thoracic Surgery 2016, 102: 1199-1205. PMID: 27261085, DOI: 10.1016/j.athoracsur.2016.03.071.Peer-Reviewed Original ResearchMeSH KeywordsAdultAortic Aneurysm, ThoracicAortic Valve InsufficiencyBlood Vessel Prosthesis ImplantationCause of DeathDatabases, FactualElective Surgical ProceduresFemaleFollow-Up StudiesHeart Valve Prosthesis ImplantationHospital MortalityHumansKaplan-Meier EstimateMaleMiddle AgedPostoperative ComplicationsRetrospective StudiesRisk AssessmentSurvival AnalysisTreatment OutcomeConceptsModerate aortic insufficiencySevere aortic insufficiencyAortic insufficiencyLong-term survivalRoot replacementWorse survivalAI patientsDecreased long-term survivalElective aortic root replacementWorse long-term survivalPreoperative aortic insufficiencyPreoperative renal failureAortic root replacementAppropriate therapeutic strategiesGreater aortic insufficiencyTiming of interventionUnited States populationRenal failureYounger patientsMultivariable predictorsSimilar patientsAortic aneurysmSingle institutionInclusion criteriaSimilar survival
2015
How to Perfuse: Concepts of Cerebral Protection during Arch Replacement
Habertheuer A, Wiedemann D, Kocher A, Laufer G, Vallabhajosyula P. How to Perfuse: Concepts of Cerebral Protection during Arch Replacement. BioMed Research International 2015, 2015: 981813. PMID: 26713319, PMCID: PMC4680049, DOI: 10.1155/2015/981813.Peer-Reviewed Original ResearchConceptsAntegrade cerebral perfusionCerebral protectionCerebral perfusionPerfusion strategyBilateral antegrade cerebral perfusionAvailable surgical strategiesCardiac surgery communityCerebral perfusion strategyComplex aortic pathologiesSingle-center dataDegree of hypothermiaComplete circulatory arrestArch replacementArch surgeryAortic pathologyArch reconstructionCirculatory arrestCirculatory managementEuropean multicenterHypothermic arrestIschemic insultThoracic aneurysmSurgical interventionSurgical strategySurgical approachDirect innominate artery cannulation: An alternate technique for antegrade cerebral perfusion during aortic hemiarch reconstruction
Jassar AS, Vallabhajosyula P, Bavaria JE, Gutsche J, Desai ND, Williams ML, Milewski RK, Hargrove WC, Szeto WY. Direct innominate artery cannulation: An alternate technique for antegrade cerebral perfusion during aortic hemiarch reconstruction. Journal Of Thoracic And Cardiovascular Surgery 2015, 151: 1073-1078. PMID: 26725716, DOI: 10.1016/j.jtcvs.2015.11.027.Peer-Reviewed Original ResearchMeSH KeywordsAgedAorta, ThoracicAortic Aneurysm, ThoracicBlood Vessel Prosthesis ImplantationBrachiocephalic TrunkCatheterization, PeripheralCerebrovascular CirculationFemaleHeart Arrest, InducedHospital MortalityHumansHypothermia, InducedMaleMiddle AgedPerfusionPostoperative ComplicationsRegional Blood FlowReoperationTime FactorsTreatment OutcomeConceptsAntegrade cerebral perfusionModerate hypothermic circulatory arrestHypothermic circulatory arrestHemiarch reconstructionInnominate arteryCerebral perfusionCirculatory arrestReversible ischemic neurologic deficitExcellent cerebral protectionInnominate artery cannulationIschemic neurologic deficitAortic valve replacementRenal failure rateProximal aortic aneurysmIncidence of injuryACP timeAscending aorticCrossclamp timeArtery cannulationCerebral protectionCentral cannulationNeurologic deficitsPatient ageRoot replacementValve replacementOutcomes of transcatheter aortic valve replacement in patients with chronic liver disease
Shah AM, Ogbara J, Herrmann HC, Fox Z, Kadakia M, Anwaruddin S, Bavaria JE, Desai ND, Jagasia D, Szeto WY, Li RH, Vallabhajosyula P, Giri J. Outcomes of transcatheter aortic valve replacement in patients with chronic liver disease. Catheterization And Cardiovascular Interventions 2015, 86: 888-894. PMID: 25963625, DOI: 10.1002/ccd.25994.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overAortic ValveAortic Valve StenosisBioprosthesisBiopsyCardiac CatheterizationChronic DiseaseFeasibility StudiesFemaleFemoral ArteryHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHospital MortalityHumansLiver DiseasesMaleMiddle AgedPatient SelectionRetrospective StudiesRisk AssessmentRisk FactorsSeverity of Illness IndexTime FactorsTreatment OutcomeConceptsTranscatheter aortic valve replacementChronic liver diseaseValve Academic Research ConsortiumAcute kidney injuryAortic valve replacementLiver diseaseLate deathsKidney injuryValve replacementUnknown causeTransapical (TA) TAVRRole of TAVRTA TAVRSevere symptomatic aortic valve stenosisModerate chronic liver diseaseSymptomatic aortic valve stenosisAdvanced liver diseaseMajor bleeding complicationsNon-cardiac causesOutcomes of patientsTransient ischemic attackAcademic Research ConsortiumHigh-risk surgeryAortic valve stenosisLong-term followModerate Versus Deep Hypothermic Circulatory Arrest for Elective Aortic Transverse Hemiarch Reconstruction
Vallabhajosyula P, Jassar AS, Menon RS, Komlo C, Gutsche J, Desai ND, Hargrove WC, Bavaria JE, Szeto WY. Moderate Versus Deep Hypothermic Circulatory Arrest for Elective Aortic Transverse Hemiarch Reconstruction. The Annals Of Thoracic Surgery 2015, 99: 1511-1517. PMID: 25825200, DOI: 10.1016/j.athoracsur.2014.12.067.Peer-Reviewed Original ResearchConceptsModerate hypothermic circulatory arrestDeep hypothermic circulatory arrestHypothermic circulatory arrestDirect innominate artery cannulationAntegrade cerebral perfusionInnominate artery cannulationCerebral perfusionCirculatory arrestHemiarch reconstructionTransfusion requirementsArtery cannulationMHCA groupCerebral perfusion strategyCerebral protection strategiesConcomitant root replacementRetrograde cerebral perfusionAortic valve replacementFresh frozen plasmaAortic aneurysm diseaseHemodialysis rateAortic reconstructionNeurologic complicationsGroup patientsPostoperative outcomesRoot replacement
2014
Distal aortic reintervention after surgery for acute DeBakey type I or II aortic dissection: open versus endovascular repair†
Rylski B, Beyersdorf F, Desai ND, Euringer W, Siepe M, Kari FA, Vallabhajosyula P, Szeto WY, Milewski RK, Bavaria JE. Distal aortic reintervention after surgery for acute DeBakey type I or II aortic dissection: open versus endovascular repair†. European Journal Of Cardio-Thoracic Surgery 2014, 48: 258-263. PMID: 25527171, DOI: 10.1093/ejcts/ezu488.Peer-Reviewed Original ResearchConceptsDeBakey type IDistal reinterventionAortic reinterventionDissection repairEndovascular groupHospital mortalityAortic pathologyAcute aortic dissection repairAcute DeBakey type IType IAortic dissection repairDistal aortic pathologyDistal aortic reinterventionOpen repair patientsEndovascular patientsLate reinterventionSpinal ischaemiaAcute dissectionEndovascular repairAortic dissectionConsecutive patientsEndovascular approachSurgical repairTertiary centerMedian timeExtracorporeal life support as rescue strategy for out-of-hospital and emergency department cardiac arrest
Johnson NJ, Acker M, Hsu CH, Desai N, Vallabhajosyula P, Lazar S, Horak J, Wald J, McCarthy F, Rame E, Gray K, Perman SM, Becker L, Cowie D, Grossestreuer A, Smith T, Gaieski DF. Extracorporeal life support as rescue strategy for out-of-hospital and emergency department cardiac arrest. Resuscitation 2014, 85: 1527-1532. PMID: 25201611, DOI: 10.1016/j.resuscitation.2014.08.028.Peer-Reviewed Original ResearchMeSH KeywordsAcademic Medical CentersAdultAgedCardiopulmonary ResuscitationConfidence IntervalsEmergency Service, HospitalExtracorporeal Membrane OxygenationFemaleFollow-Up StudiesHeart ArrestHospital MortalityHumansLife Support SystemsMaleMiddle AgedOut-of-Hospital Cardiac ArrestPhiladelphiaProspective StudiesRegistriesRisk AssessmentSurvival AnalysisTreatment OutcomeConceptsEmergency department cardiac arrestED cardiac arrestCardiac arrestLife supportRescue strategyUrban academic medical centerInitiation of ECLSHours of admissionInitial cardiac rhythmExtracorporeal life supportPulseless ventricular tachycardiaInitial cardiac arrestConventional cardiopulmonary resuscitationAcademic medical centerHospital dischargeIschemic eventsConsecutive patientsPrimary outcomePatient selectionInstitution experienceVentricular tachycardiaECLS cannulationVentricular fibrillationCardiopulmonary resuscitationMedical CenterLong-term results of aggressive hemiarch replacement in 534 patients with type A aortic dissection
Rylski B, Milewski RK, Bavaria JE, Vallabhajosyula P, Moser W, Szeto WY, Desai ND. Long-term results of aggressive hemiarch replacement in 534 patients with type A aortic dissection. Journal Of Thoracic And Cardiovascular Surgery 2014, 148: 2981-2985. PMID: 25112930, DOI: 10.1016/j.jtcvs.2014.05.093.Peer-Reviewed Original ResearchMeSH KeywordsAcute DiseaseAgedAged, 80 and overAortic Aneurysm, ThoracicAortic DissectionBlood Vessel Prosthesis ImplantationFemaleHospital MortalityHumansKaplan-Meier EstimateLogistic ModelsMaleMiddle AgedMultivariate AnalysisOdds RatioPostoperative ComplicationsReoperationRetrospective StudiesRisk FactorsTime FactorsTreatment OutcomeConceptsDeBakey type IDistal aortic reinterventionHemiarch replacementAcute typeAortic reinterventionAortic dissectionDeBakey type I dissectionAdverse aortic eventsType I dissectionAortic arch aneurysmLong-term resultsType IAortic wall tissueDistal reinterventionHospital mortalityAortic eventsReoperation rateTotal archArch aneurysmIndependent predictorsReinterventionStudy populationMarfan syndromePatientsLower mortalityAortic Valve Morphology Determines the Presentation and Surgical Approach to Acute Type A Aortic Dissection
Rylski B, Desai ND, Bavaria JE, Vallabhajosyula P, Moser W, Pochettino A, Szeto WY, Milewski RK. Aortic Valve Morphology Determines the Presentation and Surgical Approach to Acute Type A Aortic Dissection. The Annals Of Thoracic Surgery 2014, 97: 1991-1997. PMID: 24786861, DOI: 10.1016/j.athoracsur.2013.12.090.Peer-Reviewed Original ResearchMeSH KeywordsAcute DiseaseAgedAortic ValveBicuspid Aortic Valve DiseaseFemaleHeart Valve DiseasesHospital MortalityHumansMaleMiddle AgedConceptsTricuspid aortic valveBAV patientsAortic valve morphologyHospital mortalityAortic dissectionTAV patientsAcute Type A Aortic DissectionBicuspid aortic valve syndromeType A Aortic DissectionValve morphologyA Aortic DissectionSevere aortic insufficiencyTotal arch replacementAortic root replacementAortic root repairMedian followProximal reoperationAcute typeArch replacementCardiogenic shockAortic insufficiencyRoot replacementAortic diameterAorta diameterSurgical approachType A Aortic Dissection After Previous Cardiac Surgery: Results of an Integrated Surgical Approach
Rylski B, Desai ND, Bavaria JE, Moser W, Vallabhajosyula P, Pochettino A, Szeto WY, Milewski RK. Type A Aortic Dissection After Previous Cardiac Surgery: Results of an Integrated Surgical Approach. The Annals Of Thoracic Surgery 2014, 97: 1582-1589. PMID: 24629304, DOI: 10.1016/j.athoracsur.2013.12.064.Peer-Reviewed Original ResearchMeSH KeywordsAgedAortic Aneurysm, ThoracicAortic DissectionBlood Vessel Prosthesis ImplantationCardiac Surgical ProceduresCause of DeathCohort StudiesFemaleFollow-Up StudiesHospital MortalityHumansKaplan-Meier EstimateLength of StayMaleMiddle AgedPatient SafetyPostoperative ComplicationsRadiographyReoperationRetrospective StudiesRisk AssessmentSeverity of Illness IndexStatistics, NonparametricSurvival AnalysisTime FactorsTreatment OutcomeConceptsPrevious cardiac surgeryPCS patientsAortic dissectionCardiac surgeryAcute typeCardiac tamponadeHospital mortality risk factorsAcceptable postoperative mortalityPostoperative stroke ratePrior myocardial revascularizationA Aortic DissectionHospital mortality rateCoronary artery diseaseMortality risk factorsCoronary malperfusionHospital mortalityPostoperative mortalityAortic repairMyocardial revascularizationStanford typeArtery diseaseSurgical repairSurgical approachRisk factorsStroke rateType A Aortic Dissection in Marfan Syndrome
Rylski B, Bavaria JE, Beyersdorf F, Branchetti E, Desai ND, Milewski RK, Szeto WY, Vallabhajosyula P, Siepe M, Kari FA. Type A Aortic Dissection in Marfan Syndrome. Circulation 2014, 129: 1381-1386. PMID: 24594630, DOI: 10.1161/circulationaha.113.005865.Peer-Reviewed Original ResearchConceptsMarfan syndromeAortic dissectionPrimary surgeryAortic dissection type AAortic arch surgeryAortic root reoperationComposite valved graftHemi-arch replacementA Aortic DissectionAortic root replacementComplex clinical courseAortic root replacement procedureLong-term resultsValve-sparing aortic root replacement procedureRoot replacement proceduresAorta interventionAortic reinterventionArch surgeryHospital mortalityRoot reinterventionRoot reoperationArch repairEmergency surgeryRoot replacementStanford type
2013
Antegrade thoracic stent grafting during repair of acute Debakey type I dissection promotes distal aortic remodeling and reduces late open distal reoperation rate
Vallabhajosyula P, Szeto WY, Pulsipher A, Desai N, Menon R, Moeller P, Musthaq S, Pochettino A, Bavaria JE. Antegrade thoracic stent grafting during repair of acute Debakey type I dissection promotes distal aortic remodeling and reduces late open distal reoperation rate. Journal Of Thoracic And Cardiovascular Surgery 2013, 147: 942-950. PMID: 24332104, DOI: 10.1016/j.jtcvs.2013.10.047.Peer-Reviewed Original ResearchMeSH KeywordsAcute DiseaseAdultAgedAortic Aneurysm, ThoracicAortic DissectionBlood Vessel ProsthesisBlood Vessel Prosthesis ImplantationEndovascular ProceduresFemaleHospital MortalityHumansKaplan-Meier EstimateMaleMiddle AgedPlastic Surgery ProceduresPostoperative ComplicationsReoperationRetrospective StudiesStentsTime FactorsTreatment OutcomeConceptsDistal aortic remodelingStandard open repairOpen repairAortic remodelingStented groupDissection repairReoperation rateAcute DeBakey type IDeBakey type I dissectionStandard groupAntegrade cerebral perfusionAortic reintervention ratesAortic reoperation ratesDeBakey type IDistal aortic reoperationFalse lumen obliterationType I dissectionCirculatory arrest timeHospital/30-day mortalityStent-graft deploymentActuarial survivalAortic reoperationHemiarch reconstructionMidterm mortalityMidterm outcomes
2012
Hybrid approaches in the treatment of aortic arch aneurysms: Postoperative and midterm outcomes
Bavaria J, Vallabhajosyula P, Moeller P, Szeto W, Desai N, Pochettino A. Hybrid approaches in the treatment of aortic arch aneurysms: Postoperative and midterm outcomes. Journal Of Thoracic And Cardiovascular Surgery 2012, 145: s85-s90. PMID: 23260461, DOI: 10.1016/j.jtcvs.2012.11.044.Peer-Reviewed Original ResearchMeSH KeywordsAgedAorta, ThoracicAortic Aneurysm, ThoracicBlood Vessel ProsthesisBlood Vessel Prosthesis ImplantationCardiopulmonary BypassEndoleakEndovascular ProceduresFemaleHeart Arrest, InducedHospital MortalityHumansKaplan-Meier EstimateMaleMiddle AgedParaplegiaPhiladelphiaReoperationRisk FactorsStentsSternotomyStrokeTime FactorsTreatment OutcomeConceptsAortic arch aneurysmThoracic endovascular repairArch vessel debranchingArch aneurysmMidterm outcomesAverage cardiopulmonary bypass timeType 1Aortic arch surgeryAortic reoperation ratesCardiopulmonary bypass timeGreater comorbid burdenHybrid arch repairSafe treatment modalityAscending Aortic AneurysmCirculatory arrest timeMedian sternotomy approachGood midterm resultsPercent of casesType III repairType II repairArch surgeryComorbid burdenCrossclamp timeParaplegia ratePostoperative endoleaks