Does total aortic arch replacement reduce mortality compared to hemiarch replacement in patients with acute type A dissection?
In acute type A dissection, total aortic arch replacement and hemiarch replacement demonstrate equivalent mortality outcomes at high-volume centers, suggesting the surgical approach should be tailored to patient presentation and surgeon experience.
Within the context of publication bias by high volume aortic centres and non-randomized data sets, there was no difference in mortality outcomes between the two groups. This analysis serves to demonstrate that for those centers doing sufficient total aortic arch activity to allow for publication, excellent and equivalent outcomes are achievable. Conclusions on differences in longer term outcome data are required. We do not, however, advocate total arch as a primary approach by all centers and surgeons irrespective of patient characteristics, but rather, a tailored approach based on surgeon and center experience and patient presentation.
Poon et al. (Sun,) studied this question.