Acute Aortic Dissection Surgery: Hybrid Debranching Versus Total Arch Replacement

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Aortic Dissection Treatment

Background:

• Acute Stanford type A aortic dissection (AAAD) is a life-threatening condition requiring prompt surgical intervention.
• The optimal surgical strategy, particularly comparing hybrid debranching and total arch replacement (TAR), remains debated across different age demographics.

Purpose of the Study:

• To compare the clinical outcomes of hybrid debranching versus total arch replacement (TAR) in patients with acute Stanford type A aortic dissection (AAAD).
• To analyze the efficacy of these strategies across different age groups, specifically focusing on patients aged 60 years and older versus those younger than 60.

Main Methods:

• A retrospective analysis was conducted at a single university medical center.
• 309 patients with AAAD who underwent either hybrid debranching or TAR surgery between 2017 and 2019 were included.
• Exclusion criteria included specific aortic landing zones, concomitant valve/coronary operations, staged TEVAR, and organ ischemia.

Main Results:

• In patients ≥60 years, hybrid debranching was associated with significantly shorter hospital stays (22.3 vs 28.6 days), lower rates of neurologic events (5.2% vs 16.7%), and reduced renal insufficiency (5.2% vs 23.8%) compared to TAR.
• Mid-term survival was higher in the hybrid group for patients ≥60 years (95.1% vs 65.2%).
• No significant differences in outcomes were observed between hybrid debranching and TAR for patients <60 years.

Conclusions:

• Hybrid debranching surgery demonstrates superior outcomes for older patients (≥60 years) with AAAD, including reduced complications and improved survival.
• For younger patients (<60 years), both hybrid debranching and TAR yield comparable results.
• Hybrid debranching presents a promising alternative surgical option for elderly patients diagnosed with AAAD.