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Updated: Dec 29, 2025
Novel and Innovative Hybrid Technique for Type A Aortic Dissection
Published on: March 28, 2025
Efficiency of Modified Triple-Branched Stent Graft in Type I Aortic Dissection: Two-Year Follow-up
Zhi-Huang Qiu1, Liang-Wan Chen1, Lian-Ming Liao2
1Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, China.
Insights
Hemiarch replacement with a triple-branched stent graft is effective for Debakey type I aortic dissection. This technique shows good long-term survival and low reintervention rates in patients.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Background:
- The efficacy of hemiarch replacement combined with a modified triple-branched stent graft for Debakey type I aortic dissection requires further confirmation.
- Acute aortic dissection poses significant surgical challenges, necessitating advanced treatment strategies.
Purpose of the Study:
- To evaluate the safety and efficacy of hemiarch replacement combined with a modified triple-branched stent graft in patients with acute Debakey type I aortic dissection.
- To identify early composite endpoints and long-term outcomes associated with this surgical approach.
Main Methods:
- A retrospective analysis of clinical and imaging data from 167 patients who underwent hemiarch replacement with a modified triple-branched stent graft for acute Debakey type I aortic dissection (January 2016 - December 2017).
- Definition of an early composite endpoint including perioperative mortality, permanent neurologic deficits, and renal failure requiring hemodialysis at discharge.
- Assessment of risk factors for the composite endpoint, including malperfusion syndrome and elevated creatine levels.
Main Results:
- The 30-day mortality rate was 4.2% (7/167), and the composite endpoint occurred in 11.4% (19/167) of patients.
- Malperfusion syndrome and creatine > 1.5 mg/dL were identified as significant risk factors for the composite endpoint.
- Two-year survival was 92.2%, with complete false lumen thrombosis in the descending aorta observed in 98.8% at the pulmonary bifurcation level.
Conclusions:
- Hemiarch replacement combined with a modified triple-branched stent graft is a reliable and effective technique for treating acute Debakey type I aortic dissection.
- The procedure demonstrates favorable early and long-term outcomes, including acceptable mortality and survival rates.
- Further research may explore optimization of this technique to further reduce complication rates.
Background:
The efficacy of hemiarch replacement combined with a modified triple-branched stent graft in Debakey type I aortic dissection remains to be confirmed.
Methods:
From January 2016 to December 2017, 167 patients with acute Debakey type I aortic dissection underwent hemiarch replacement combined with a modified triple-branched stent graft. The clinical and imaging data were retrospectively analyzed. The early composite endpoint was defined to comprise perioperative mortality, permanent neurologic deficits, and renal failure requiring hemodialysis at discharge.
Results:
The overall 30-day mortality was 4.2% (7 of 167). The incidence of the composite endpoint was 11.4% (19 of 167). The risk factors for the composite endpoint were malperfusion syndrome (odds ratio 5.17; 95% confidence interval, 1.46 to 18.35; P = .011) and creatine greater than 1.5 mg/dL (odds ratio 5.44; 95% confidence interval, 2.27 to 13.06; P < .001). The overall survival was 94% at 1 year and 92.2% at 2 years during a median follow-up of 20.9 ± 9.6 months. Three patients required distal aorta reintervention. Complete thrombosis in the false lumen of the descending aorta at the level of the pulmonary bifurcation and at the level of the celiac trunk was observed in 98.8% and 10.8% of the patients, respectively.
Conclusions:
Hemiarch replacement combined with a modified triple-branched stent graft is a reliable technique for acute Debakey type I aortic dissection as indicated by 2 years of follow-up.
