Acute aortic dissection with entry tear at the aortic arch: long-term outcome

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Vascular Surgery

Background:

• Acute aortic arch dissection is a rare and complex cardiovascular emergency.
• Optimal management strategies remain a subject of debate.
• Early diagnosis and intervention are crucial for patient outcomes.

Purpose of the Study:

• To compare the outcomes of conservative versus surgical management for acute aortic arch dissections.
• To identify factors influencing treatment decisions and long-term prognosis.
• To evaluate the impact of treatment modality on survival and neurological events.

Main Methods:

• Retrospective analysis of 31 patients diagnosed with acute aortic dissection between 2009 and 2018.
• Definition of aortic arch dissection: isolated entry tear in the aortic arch without ascending aorta involvement.
• Comparison of in-hospital mortality, stroke rate, overall survival, and need for re-intervention between surgical and conservative groups.

Main Results:

• Surgical intervention was performed in 13 patients (41.9%) for malperfusion, impending rupture, or refractory pain.
• Overall in-hospital mortality was 3% (one death in the conservative group).
• Overall survival at follow-up was 71%, with no significant difference between groups (77% surgical vs. 63% conservative, P=0.91).
• Freedom from neurological events was similar (89% vs. 89%, P=0.68).

Conclusions:

• Acute aortic arch dissection presents significant management challenges.
• Patients with an initially uneventful course managed conservatively had a higher risk of late aorta-related interventions.
• Treatment modality did not significantly impact overall survival or the incidence of neurological events in this cohort.