Non-A non-B acute aortic dissection with entry tear in the aortic arch

Our aim was to describe the outcomes of the latest treatment options of acute non-A non-B aortic dissection involving an entry tear in the aortic arch.

Included were patients who presented between January 2001 and February 2020 with a non-A non-B aortic dissection involving the aortic arch but not the ascending aorta and with the most proximal entry tear located within the aortic arch between the innominate and left subclavian artery. Clinical data and operative details were retrieved from medical histories and surgical protocols. Preoperative, postoperative and follow-up computed tomography angiography scans were analysed.

We analysed a total of 39 patients [median age 62 (52; 67) years, men 76.9%] with non-A non-B arch entry aortic dissections type. They underwent 15 thoracic endovascular aortic repairs, 20 frozen elephant trunk implantations, 1 hybrid arch replacement, or 1 conventional arch replacement. Two patients were managed conservatively. Twelve (31%) patients underwent emergent intervention, 12 (31%) were treated invasively within 2 weeks. Another 2 (5%) and 9 (23%) patients were treated 2 and 4 weeks after dissection occurred, respectively. Six (15%) patients presented with an impending aortic rupture, while 19 (49%) had at least one malperfused organ. Four patients (27%) died after thoracic endovascular aortic repair; the 30-day mortality following frozen elephant trunk was 0%.

Non-A non-B acute aortic dissection reveals a frequently complicated course requiring emergency intervention. The majority of patients required aortic arch repair within the first 2 weeks. Total arch replacement with the frozen elephant trunk technique seems to be low procedural mortality, and may become the treatment of choice in arch entry non-A non-B aortic dissection.