[Strategy to Avoid Reoperation after Ascending Aortic Replacement for DeBakey TypeⅠ Acute Aortic Dissection]

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Aortic Disease Management

Background:

• Residual false lumen in the aortic arch after ascending aortic replacement for DeBakey type I acute aortic dissection is a significant risk factor for reoperation.
• Entry resection has been the primary surgical approach, with brachiocephalic artery reconstruction added since 2013 for specific re-entry cases.

Purpose of the Study:

• To investigate whether brachiocephalic artery reconstruction improves false lumen thrombosis in the aortic arch post-ascending aortic replacement.
• To assess the impact of brachiocephalic artery reconstruction on the incidence of residual aortic arch false lumen.

Main Methods:

• Retrospective analysis of 68 patients undergoing ascending aortic replacement for DeBakey type I acute aortic dissection over 12 years.
• Comparison of 6 patients with brachiocephalic artery reconstruction (Group A) versus 11 without (Group B) who had preoperative brachiocephalic artery re-entry.

Main Results:

• No residual aortic arch false lumen was observed postoperatively in Group A (0%), compared to 90.9% in Group B (p=0.0006).
• Surgical times for aortic clamping and selective cerebral perfusion were significantly longer in Group A.
• The risk of residual aortic arch false lumen was significantly reduced in patients who underwent brachiocephalic artery reconstruction.

Conclusions:

• In acute aortic dissection with brachiocephalic artery re-entry, a residual false lumen in the aortic arch is common after ascending aortic replacement.
• Reconstruction of the dissected brachiocephalic artery effectively obliterates the aortic arch false lumen, potentially preventing late reoperations.