How much is Necessary when Managing the Arch in Acute Type A Aortic Dissection?

Background: Conservative operative treatment of acute type A aortic dissection includes intimal tear resection and replacement of the ascending aorta. Current trends are directed toward extensive arch procedures. The aim of this study is to demonstrate early and late outcomes including aortic arch reoperations during follow-up after conservative aortic repair.

Methods: We present a single center analysis of 375 patients treated for acute type A aortic dissection between 1/2010 and 12/2023. Baseline characteristics, operative details, and follow-up reports, including regular computed tomography and aortic re-interventions, are presented. Follow-up events and survival rates are analyzed up to 14 years. The main focus was aortic redo and arch surgery; additional outcomes included early mortality and complications as well as survival during follow-up.

Results: The mean age of all patients was 64 ± 13; 37% were female (N = 137). Eight percent of patients had a confirmed bicuspid aortic valve (N = 29). The majority of cases were DeBakey type I dissections (73%, N = 274) with the entry located in the ascending aorta (60%, N = 225). The axillary artery was predominantly used for arterial bypass (74%, N = 277), utilizing unilateral antegrade cerebral perfusion in most cases (90%, N = 337). An aortic hemiarch replacement was performed in 69% of cases (N = 259). Only 9% of cases (N = 33) were treated by complete arch replacement. Early mortality (30 days or in-house) was 12% (N = 43). Five- and 10-year survival was 87 ± 3% and 76 ± 6%, respectively. Freedom from arch-related reoperations at 5 and 10 years was 91 ± 3% and 61 ± 8%.

Conclusion: The results demonstrate that the primary objective of patient survival can be achieved with good results when applying a relatively conservative operative strategy. Within 5 years up to 10% of patients required redo surgery involving complete arch replacement (after initial ascending or hemiarch surgery). Early outcome of patients undergoing reoperation for the aortic arch is good, which raises the question whether this approach ultimately yields better overall long-term results. Further analyses are warranted to adequately assess the incidence of reoperative surgery after primary aggressive arch operations in comparison to the herein presented data.

Publication History

Article published online:
11 February 2025