Long-term effectiveness of total arch replacement for type A aortic dissection.

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Aortic Disease

Background:

• Total aortic arch replacement is an accepted method for acute type A aortic dissection involving the aortic arch.
• Recent advancements in cerebral protection have improved surgical outcomes.
• The study focuses on a specific surgical strategy for this condition.

Purpose of the Study:

• To evaluate the effectiveness of total arch replacement with antegrade selective cerebral perfusion.
• To assess the late outcomes of this surgical strategy in patients with acute type A aortic dissection.
• To determine the long-term survival and complication rates.

Main Methods:

• 46 patients with acute type A aortic dissection underwent total arch replacement.
• Procedures utilized hypothermic cardiopulmonary bypass and antegrade selective cerebral perfusion.
• Open distal anastomosis was performed during the repair.

Main Results:

• Hospital mortality was 6.5%, with one case of permanent neurologic dysfunction.
• Long-term survival rates at 5 and 10 years were 89.6% and 82.7%, respectively.
• Freedom from reoperation was high (93.6% at 5 years, 88.7% at 10 years), with frequent thrombosis of the residual false lumen (76.2%).

Conclusions:

• Total arch replacement for acute type A dissection may reduce late false lumen-related complications.
• This strategy is associated with excellent long-term survival.
• The technique demonstrates favorable outcomes for managing complex aortic arch pathology.