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Updated: Jan 30, 2026
Novel and Innovative Hybrid Technique for Type A Aortic Dissection
Published on: March 28, 2025
Conservative treatment of type A aortic dissection following hybrid arch repair
Tomo Yoshizumi1, Yoshiyuki Tokuda2, Tomonobu Abe2
1Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan. tyoshizumi@med.nagoya-u.ac.jp.
Insights
Type A aortic dissection (TAAD) after hybrid arch repair (HAR) is a serious complication. Conservative management may be an option for stable patients, requiring careful monitoring.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Background:
- Type A aortic dissection (TAAD) post-hybrid arch repair (HAR) presents significant mortality risks.
- Open surgical repair is ideal but often unfeasible for patients with comorbidities.
- This study examines TAAD cases following HAR to assess treatment strategies.
Observation:
- Three TAAD cases occurred after HAR between 2010 and 2018.
- Patients were elderly with high-risk comorbidities.
- TAAD was detected post-operatively (POD 11, POD 11) or intraoperatively.
Findings:
- One patient died from aortic rupture; two survived over 50 months.
- No additional open aortic repairs were performed.
- Conservative therapy was used for subacute TAAD with stable hemodynamics.
Implications:
- Post-operative imaging is crucial for detecting TAAD after HAR.
- Conservative management can be viable for select TAAD patients post-HAR.
- Careful follow-up is essential for patients managed conservatively.
Objective:
Type A aortic dissection (TAAD) following hybrid arch repair (HAR) is a lethal complication. Open surgical repair is the ideal treatment, but this can be difficult, as most candidates have complications and are unsuitable for the conventional open aortic repair. We herein report three cases of TAAD after HAR and assess the treatment options.
Methods:
Of 261 aortic arch repair cases between April 2010 and March 2018, 38 underwent HAR using debranching of all the arch vessels followed by stent graft implantation landing proximally in zone 0 (type 1 HAR). Three cases suffered from TAAD, and their background characteristics and post-operative outcomes were studied retrospectively.
Results:
The three TAAD cases were elderly with a high risk of mortality due to comorbidities. TAAD for Cases 1, 2, and 3 was detected on post-operative day (POD) 11, POD11, and during the procedure, respectively. Case 1 was complicated with both respiratory and renal failures, and Case 3 suffered from severe neurological impairment when TAAD was detected. No additional open aortic repair was performed in any cases. Case 3 died on POD5 due to aortic rupture. Cases 1 and 2 have survived for more than 50 months since their initial surgeries.
Conclusions:
TAAD following HAR can be detected with post-operative imaging despite a lack of signs noted during the intra- and post-operative periods. Conservative therapy might, therefore, be an acceptable option for subacute-onset TAAD following HAR with stable hemodynamics, even though such patients do required a very careful follow-up.
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