Total Arch Replacement Versus More Conservative Management in Type A Acute Aortic Dissection

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Aortic Disease Management

Background:

• Surgical management of type A acute aortic dissection (TAAD) involving the aortic arch remains a subject of debate.
• This study aimed to compare outcomes between total arch replacement (TAR) and more conservative arch management (CAM) in TAAD patients.

Purpose of the Study:

• To compare the short-term and long-term efficacy of TAR versus CAM in patients with TAAD.
• To identify predictors of hospital mortality and long-term outcomes in TAAD management.

Main Methods:

• A retrospective analysis of 240 TAAD patients treated between 1997 and 2012.
• Comparison of outcomes between 53 patients undergoing TAR and 187 patients receiving CAM.
• Propensity score adjustment was used to control for baseline differences.

Main Results:

• Hospital mortality rates were similar between TAR and CAM groups (24.1% vs 22.6%).
• No significant differences were observed in major postoperative complications, 7-year survival, or freedom from aortic re-intervention.
• Age and cardiopulmonary bypass time were independent predictors of hospital death.

Conclusions:

• Both TAR and CAM demonstrated comparable hospital mortality and morbidity rates in TAAD patients.
• Extensive arch interventions (TAR) did not confer superior long-term survival or reduced need for re-intervention compared to CAM.
• The choice between TAR and CAM should be guided by the intimal tear location and patient-specific factors.