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Novel and Innovative Hybrid Technique for Type A Aortic Dissection
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Outcomes of Carotid Artery Replacement With Total Arch Reconstruction for Type A Aortic Dissection

Ibrahim Sultan1, Edgar Aranda-Michel2, Valentino Bianco2

  • 1Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.

The Annals of Thoracic Surgery
|November 29, 2020
PubMed

Insights

Concomitant carotid artery replacement during total arch repair for acute type A aortic dissection is safe. This procedure effectively addresses cerebral malperfusion and carotid dissection without impacting long-term survival or stroke rates.

Area of Science:

  • Cardiovascular Surgery
  • Vascular Surgery
  • Thoracic Surgery

Background:

  • Acute type A aortic dissection (TAAD) poses significant risks, particularly cerebral malperfusion and carotid artery dissection.
  • Outcomes data for combined carotid artery replacement with total arch repair in TAAD patients are limited.

Purpose of the Study:

  • To evaluate the safety and efficacy of concomitant carotid artery replacement during total arch replacement for acute TAAD.
  • To compare outcomes between patients undergoing conventional total arch replacement and those receiving additional carotid artery repair.

Main Methods:

  • Retrospective analysis of 161 patients undergoing total arch replacement for acute TAAD (2007-2018).
  • Comparison of 111 patients with conventional reconstruction versus 50 patients with concomitant carotid artery replacement.
  • Kaplan-Meier survival estimates and Cox regression analysis for mortality predictors.

Main Results:

  • The carotid replacement cohort had higher rates of preoperative cerebral malperfusion (48%) and stroke (28%) compared to the conventional group.
  • No significant difference in 30-day, 1-year, or 5-year mortality between the two groups.
  • Postoperative stroke rates were similar (0% vs. 4.5%), with a trend towards fewer strokes in the carotid replacement group.

Conclusions:

  • Concomitant carotid artery replacement is a safe and feasible strategy for managing cerebral malperfusion and carotid dissection in TAAD.
  • This approach does not compromise long-term survival or increase postoperative stroke risk compared to conventional total arch replacement.
Abstract

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