Total arch replacement in the treatment of acute type A aortic dissection

The role of total arch replacement (TAR) in patients with acute type A aortic dissection (ATAD) has been much debated. There are numerous factors that contribute to the clinical decision-making process. These include patient cohort, clinical status of the patient, aortic anatomy, dissection morphology, and expertise of the surgeon and the center. In this review, we summarize early and late outcomes of TAR in ATAD patients and discuss the specific patient populations that may benefit from an aggressive surgical approach at the time of the initial acute presentation. We discuss techniques for TAR, differences in aortic remodeling, and long-term aortic prognosis of these patients.