Surgical outcomes for acute type A aortic dissection with aggressive primary entry resection

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Aortic Dissection

Background:

• Acute type A aortic dissection (AAAD) with an entry tear at the aortic arch is uncommon.
• The optimal surgical strategy for AAAD involving the aortic arch, particularly regarding primary entry resection, remains debated.

Purpose of the Study:

• To evaluate the efficacy of an aggressive surgical strategy involving primary entry resection for AAAD.
• Specifically, to assess outcomes in patients undergoing hemiarch or total arch replacement (TAR) for arch tears.

Main Methods:

• Retrospective review of 334 patients with AAAD undergoing emergent surgery between 2000 and 2014.
• An aggressive surgical strategy prioritizing primary entry resection was employed, including hemiarch (52%) and TAR (48%) replacements.
• Follow-up data were collected for 96% of hospital survivors.

Main Results:

• The 30-day and in-hospital mortality rates were 5.4% and 8.4%, respectively.
• Postoperative complications included permanent neurological dysfunction (6.9%), tracheotomy (8%), and new permanent hemodialysis (2%). No spinal cord injuries were observed.
• Complete false lumen thrombosis was achieved in 57% of patients, with 3, 5, and 10-year survival rates of 81%, 74%, and 65%, respectively. Freedom from reoperation was 89%, 86%, and 80% at these time points.

Conclusions:

• Aggressive primary entry resection in AAAD provides satisfactory surgical outcomes.
• This approach facilitates a high rate of false lumen thrombosis, significantly reducing the incidence of downstream aortic reoperations.