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Total arch replacement: When and how?

Kenji Okada1

  • 1Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.

Asian Cardiovascular & Thoracic Annals
|May 5, 2022
PubMed
Summary
This summary is machine-generated.

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Acute type A aortic dissection requires open surgery. Total arch replacement may be superior to hemiarch replacement for select patients, improving long-term outcomes.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Aortic Disease

Background:

  • Acute type A aortic dissection (ATAAD) is a critical condition with high mortality.
  • Open aortic surgery is essential for ATAAD, especially in elderly patients.
  • Current treatments include hemiarch replacement (HAR) and total arch replacement (TAR).

Purpose of the Study:

  • To compare the efficacy and outcomes of HAR versus TAR for ATAAD.
  • To identify optimal patient selection criteria for TAR in ATAAD management.
  • To evaluate the impact of emerging technologies like the frozen elephant trunk on TAR procedures.

Main Methods:

  • Review of surgical techniques for ATAAD, focusing on HAR and TAR.
  • Analysis of patient selection factors influencing surgical approach.
Keywords:
Aortic dissectionacutetotal arch replacementtype A

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  • Discussion of advancements in aortic grafting and brain protection strategies.

    • Main Results:

    • HAR may lead to new anastomotic entries and unfavorable distal remodeling.
    • TAR, though demanding, offers benefits for specific patient groups.
    • Frozen elephant trunk technology enhances TAR applicability and outcomes.

    Conclusions:

    • Appropriate selection of surgical technique is crucial for maximizing open surgery benefits in ATAAD.
    • TAR may be the preferred option over HAR for selected ATAAD patients, including younger individuals or those with specific aortic pathologies.
    • Continued evidence is needed to solidify TAR as the optimal choice for broader ATAAD patient populations.