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Outcomes of hemi- vs. total arch replacement in acute type A aortic dissection: A systematic review and meta-analysis

Likang Ma1,2,3, Tianci Chai1,2,3, Xiaojie Yang4

  • 1Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, China.

Frontiers in Cardiovascular Medicine
|October 14, 2022
PubMed

Insights

Hemiarch replacement for acute type A aortic dissection shows better early outcomes, including lower mortality and fewer complications. However, it is associated with a higher late mortality rate compared to total arch replacement.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Aortic Surgery

Background:

  • Acute type A aortic dissection (ATAAD) presents significant surgical challenges with high mortality rates.
  • The optimal surgical strategy, specifically hemiarch versus total arch replacement, remains a subject of debate.

Approach:

  • A systematic review and meta-analysis was conducted, searching major databases for comparative studies.
  • Included 23 observational studies involving 4,576 patients comparing hemiarch and total arch replacement for ATAAD.

Key Points:

  • Hemiarch replacement demonstrated significantly lower early mortality (RR=0.82), postoperative permanent neurological dysfunction (RR=0.72), and renal failure/dialysis (RR=0.82).
  • Conversely, hemiarch replacement was associated with a higher rate of late mortality (RR=1.37).
  • No significant differences were observed in re-operation for bleeding, aortic re-operation, or pneumonia.

Conclusions:

  • Hemiarch replacement offers superior early outcomes in ATAAD management.
  • Total arch replacement may be associated with better long-term survival.
  • Surgical decisions should consider dissection extent and surgeon experience for optimal patient prognosis.
Abstract

Keywords:
adulthemiarch replacementmeta-analysistotal arch replacementtype A aortic dissection

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