Procedure duration and early postoperative stroke after endovascular and hybrid aortic arch reconstruction for acute aortic syndrome: a single-center retrospective cohort study.

OBJECTIVE

Acute aortic syndrome (AAS) with an inadequate proximal landing zone often requires aortic arch reconstruction using endovascular branch techniques or hybrid supra-aortic debranching plus TEVAR. Despite technical advances, early postoperative stroke remains a clinically important complication. Procedure duration may reflect procedural complexity and cumulative cerebral embolic/hypoperfusion burden, yet its association with early stroke after contemporary arch reconstruction strategies is not well characterized.

METHODS

We retrospectively analyzed consecutive AAS patients undergoing aortic arch reconstruction with either Zone 2 single-branch stent-assisted TEVAR or hybrid surgery (supra-aortic bypass with subsequent TEVAR) between January 2017 and December 2023. The primary endpoint was ischemic stroke within 30 days after the procedure, confirmed by imaging. We evaluated the relationship between procedure duration and early stroke using multivariable regression models adjusting for key clinical confounders (age, sex, BMI, hypertension, diabetes, coronary artery disease, prior stroke, and renal insufficiency). Discriminative performance for procedure time was explored using ROC analysis.

RESULTS

A total of 235 patients were included (mean age 60.7 ± 10.6 years; 84.7% male). Procedure duration was longer in the hybrid group than in the Zone 2 single-branch TEVAR group (249.0 ± 72.3 vs. 110.4 ± 43.3 min, P < 0.001). Early postoperative stroke occurred in 17 patients (7.2%), with a higher incidence in the hybrid group than in the Zone 2 single-branch TEVAR group (11.1% vs. 3.9%, P = 0.034). Procedure duration was independently associated with early stroke after adjustment (adjusted HR 1.012 per minute, 95% CI 1.006-1.018; P < 0.001). In exploratory analyses, a procedure-time cut-point of 273 min showed good discrimination for early stroke (AUC = 0.81).

CONCLUSIONS

In this single-center cohort of AAS patients undergoing aortic arch reconstruction, longer procedure duration was associated with a higher risk of early postoperative stroke, independent of measured comorbidities. Procedure duration may serve as a pragmatic marker of procedural complexity and cerebral risk exposure, supporting quality-improvement efforts aimed at workflow optimization and risk stratification.