Rupture-oriented strategy for acute type A aortic dissection

Objective. To evaluate the immediate and long-term results of surgical treatment of acute aortic dissection type A using rupture-oriented strategy. Material and methods. A prospective study included 157 patients with acute aortic dissection type A who were divided into 2 groups: group 1 — 123 people (inner wall rupture in ascending aorta or lesser curvature of aortic arch) underwent ascending aorta replacement and, if necessary, hemiarch procedure, group 2 — 34 patients (inner wall rupture in aortic arch (except for lesser curvature) or no rupture in ascending aorta and aortic arch, aortic arch aneurysm) underwent ascending aorta and aortic arch replacement. Early and late postoperative results were assessed. Results. In-hospital mortality was similar (13.8% and 14.7%, respectively, p=0.9). Early postoperative morbidity (bleeding, myocardial infarction, neurological complications, acute renal failure) was similar. Five-year survival rate was 74% and 82%, respectively (p=0.97), five-year freedom from redo aortic surgery — 88% and 90%, respectively (p=0.75). Conclusion. Rupture-oriented surgical strategy for acute aortic dissection type A may be used without worsening immediate and long-term results, especially in hospitals without extensive experience in aortic surgery.