Related Experiment Video
Updated: Aug 27, 2025
Novel and Innovative Hybrid Technique for Type A Aortic Dissection
Published on: March 28, 2025
Effects of Residual Arch Tears on Late Outcomes After Hemiarch Replacement for DeBakey I Dissection
Do Jung Kim1, Joon-Young Song2, Han-Bit Shin3
1Department of Thoracic and Cardiovascular Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea; Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
Insights
Residual arch tears after aortic dissection repair increase arch dilatation and reintervention risk. Distal arch tears are particularly concerning, suggesting more extensive initial repair may improve outcomes.
Area of Science:
- Cardiovascular Surgery
- Aortic Dissection Research
- Medical Device Technology
Background:
- DeBakey type I aortic dissection requires surgical repair, often involving hemiarch replacement.
- Residual arch tears post-surgery can impact long-term patient outcomes.
- Understanding the influence of residual tears is crucial for refining surgical strategies.
Purpose of the Study:
- To evaluate the impact of residual arch tears on late reinterventions and aortic arch dilatation.
- To investigate the relationship between the location of residual tears and arch growth rates.
- To identify factors influencing long-term outcomes after hemiarch replacement for aortic dissection.
Main Methods:
- Retrospective analysis of 160 patients undergoing hemiarch replacement for DeBakey type I dissection.
- Patients categorized based on the presence and location (proximal/middle vs. distal arch) of residual arch tears.
- Arch growth rates and late arch/composite events were assessed over time.
Main Results:
- Patients with residual arch tears showed significant arch diameter increase (1.620 mm/y).
- Distal arch tears were associated with more rapid arch growth (2.101 mm/y) compared to proximal/middle tears (1.001 mm/y).
- Residual arch tears significantly lowered 10-year freedom from late arch events (82.4% vs. 95.5%) and composite events (68.0% vs. 89.3%).
Conclusions:
- Residual arch tears are significant predictors of late arch dilatation and reinterventions.
- Distal residual arch tears pose a higher risk for adverse aortic events.
- Comprehensive arch replacement during initial surgery may enhance long-term results in DeBakey type I aortic dissection.
Background:
This study evaluated the effect of residual arch tears on late reinterventions and arch dilatation after hemiarch replacement for patients with acute DeBakey type I aortic dissection.
Methods:
Between January 1995 and October 2018, 160 consecutive patients who underwent hemiarch replacement for DeBakey type I dissection were retrospectively enrolled. They were divided into patients with (n = 73) and without (n = 87) residual arch tears. The arch tears group was subdivided into the proximal/middle arch (n = 26) and distal arch (n = 47) groups to evaluate arch growth rates according to the locations of residual arch tears. The endpoints were arch growth rate and late arch and composite events.
Results:
The arch diameter increased significantly over time in patients with residual arch tears (1.620 mm/y, P < .001). The increase occurred more rapidly when residual tears occurred at the distal arch than at the proximal/middle arch level (2.101 vs 1.001 mm/y). In the adjusted linear mixed model, residual arch tears or luminal communications at the distal arch level were significant factors associated with increases in the arch diameter over time. The 10-year freedom from late arch and composite event rate was significantly lower for patients with residual arch tears than for those without (82.4% vs 95.5%, P = .001; and 68.0% vs 89.3%, P = .002, respectively).
Conclusions:
Residual arch tears are significant factors associated with late arch dilatation and reinterventions, especially for patients with distal arch tears. Extensive arch replacement during the initial surgery to avoid residual arch tears may improve long-term outcomes.
