Is total arch replacement associated with an increased risk after acute type A dissection?

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Aortic Dissection Research

Background:

• Acute type A aortic dissection (AADA) surgical management typically involves reconstructing the ascending aorta.
• The debate continues regarding the optimal surgical approach: ascending aorta replacement (AAR) versus total aortic arch replacement (TAAR).
• This study aimed to compare 30-day mortality rates between AAR and TAAR in AADA surgery.

Purpose of the Study:

• To compare the 30-day mortality between ascending aorta replacement (AAR) and total aortic arch replacement (TAAR) in patients with acute type A aortic dissection (AADA).
• To identify risk factors associated with 30-day mortality in AADA surgery.
• To inform surgical strategy decisions by evaluating short-term outcomes of different AADA repair methods.

Main Methods:

• Retrospective analysis of 339 patients undergoing AADA surgery between January 2001 and December 2016.
• Propensity score-matched analysis comparing AAR and TAAR groups (43 patients each).
• Multivariable analysis to determine risk factors for 30-day mortality.

Main Results:

• AAR was performed in 86.1% of patients, TAAR in 13.9%.
• Operative times and cardiopulmonary bypass durations were significantly longer for TAAR.
• Overall 30-day mortality was 17.7%, with no significant difference between AAR (16.8%) and TAAR (23.4%) groups, even after propensity score matching.

Conclusions:

• While 30-day mortality and postoperative morbidity are comparable between AAR and TAAR for AADA, complete aortic restoration is the therapeutic goal.
• Surgical strategy decisions should balance the operative risks of TAAR against potential long-term benefits.
• Further consideration of long-term outcomes is essential when choosing between AAR and TAAR in AADA treatment.