Key result
Total aortic arch replacement during initial repair of acute type A aortic dissection eliminated the need for subsequent open distal reoperations compared to limited ascending aorta or hemiarch replacement (0% vs 9.7%, p<0.001).
Why the study?
Whether initial repair in patients with acute type A aortic dissection should also include aortic arch replacement to prevent reoperations remains debated.
Does extensive aortic repair (ascending aorta/arch replacement) reduce the incidence of distal reoperations compared to hemiarch replacement in patients with acute type A aortic dissection?
Cohort (n=285)
No
Does extensive aortic repair (ascending aorta/arch replacement) reduce the incidence of distal reoperations compared to hemiarch replacement in patients with acute type A aortic dissection?
Absolute Event Rate: 0% vs 9.7%
p-value: p=<0.001
Extensive initial repair of acute type A aortic dissection with arch replacement is associated with a lower rate of open distal reoperation and better mid-term survival compared to hemiarch replacement.
Arch replacement may reduce distal reoperations after A-AAD repair; leaves open optimal initial strategy pending prospective data.
Background and Aim of the Study: In patients with acute type A aortic dissection (A-AAD) whether initial repair should include also aortic arch replacement is still debated. We aimed to assess if extensive aortic repair prevents from reoperations patients with A-AAD. Methods: Outcomes after distal reoperation following repair of A-AAD (n = 285; 1977 to 2018) were analysed in 22 of 226 who underwent ascending aorta/hemiarch replacement (Group 1R) and 7 of 59 who had ascending aorta/arch replacement (Group 2R). Results: Distal reoperation was more common in Group 1R (n = 22) than in Group 2R (n = 0) (p < 0.001) while thoracic endovascular stenting was more frequent in Group 2R (7 vs 3, p < 0.001). Indications for reoperation were pseudoaneurysm at distal anastomosis (n = 4, 18%) and progression of aortic dissection (n = 18, 82%) in Group 1R. Indication for thoracic endovascular stenting was progressive aortic dissection in 3 patients of Group 1R and in 6 of Group 2R. Second reoperation was required in 2 patients from Group 1R (2%) during a mean follow-up of 5 years. Median follow-up was 4 years in Group 1R and 7 years in Group 2R (p = 0.36). Hospital mortality was 14% in Group 1R and 0% in Group 2R (p = 0.3). Actuarial survival is 68 ± 10%, and 62 ± 11% for Group 1R and 100% for Group 2R at 5 and 10 years (p = 0.076). Conclusions: Distal reoperations after A-AAD repair have an acceptable mortality. An extensive initial repair has lower rate of reoperation and better mid-term survival and should be indicated especially for young patients in experienced centers.
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Vendramin et al. (2022) conducted a cohort in Acute type A aortic dissection (n=285). Total aortic arch replacement vs. Ascending aorta or hemiarch replacement was evaluated on Open distal reoperation (p=<0.001). Total aortic arch replacement during initial repair of acute type A aortic dissection eliminated the need for subsequent open distal reoperations compared to limited ascending aorta or hemiarch replacement (0% vs 9.7%, p<0.001).
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