Surgical strategy for retrograde type A aortic dissection based on long-term outcomes.

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Aortic Disease Management

Background:

• Optimal management of retrograde type A aortic dissection (RAAD) remains controversial.
• Limited data exists on long-term outcomes of surgical strategies for RAAD.

Purpose of the Study:

• To evaluate and compare the early and late outcomes of different surgical strategies for RAAD.
• To identify predictors of long-term aortic events after RAAD repair.

Main Methods:

• Retrospective analysis of 44 RAAD patients undergoing surgical repair (1998-2014).
• Comparison of ascending aortic replacement (AAR) versus ascending and total arch replacement (TAR).
• Subgroup analysis of TAR with complete tear resection (TAR-R[+]) versus elephant trunk implantation (TAR-R[-]).

Main Results:

• Hospital mortality was 9.1% overall, with no deaths in the TAR-R[-] group.
• AAR group showed a higher incidence of late aorta-related events and false lumen patency.
• 5-year freedom from aortic growth >50mm was significantly lower after AAR compared to TAR (p=0.04).
• Initial ascending aortic diameter and AAR were independent predictors of late aortic expansion.

Conclusions:

• Both AAR and TAR demonstrated acceptable surgical outcomes.
• Long-term results suggest potential benefit of aggressive TAR adoption.
• TAR may be preferable in younger patients with significant ascending aortic enlargement.