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Distal Aortic Progression After Hemiarch, Zones 1-3 Arch Replacement in Acute Type A Aortic Dissection

Nathan J Graham1, Marc Titsworth1, Rana-Armaghan Ahmad1

  • 1Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Michigan.

The Annals of Thoracic Surgery
|November 11, 2022
PubMed

Insights

The extent of aortic arch repair in acute type A aortic dissection (ATAAD) does not significantly impact long-term survival or distal aorta growth. Patient-specific strategies can guide repair extent, avoiding routine aggressive arch replacement.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Aortic Disease

Background:

  • Debate exists regarding the optimal extent of aortic arch repair for patients with acute type A aortic dissection (ATAAD).
  • Current practices vary, with some advocating for more extensive arch replacement.
  • Understanding the long-term implications of different repair extents is crucial for patient management.

Purpose of the Study:

  • To compare the long-term outcomes of different extents of aortic arch replacement in ATAAD patients.
  • To evaluate the impact of hemiarch versus zone 1, 2, or 3 arch replacement on distal aorta growth and reoperation rates.
  • To inform surgical decision-making for ATAAD repair.

Main Methods:

  • A retrospective analysis of 756 ATAAD patients who underwent open arch replacement from 1996 to 2021.
  • Patients were categorized into hemiarch, zone 1, zone 2, and zone 3 arch replacement groups.
  • Distal aorta growth was assessed using serial postoperative imaging (CT or MRI), with 10-year follow-up for survival and reoperation rates.

Main Results:

  • No significant demographic differences were observed between groups, except for higher rates of coronary artery disease and lower stroke rates in the hemiarch group.
  • Zones 1, 2, and 3 required longer operative times and more transfusions than hemiarch repair.
  • Ten-year cumulative reoperation rates (hemiarch: 16.7%, zone 1: 16.3%, zone 2: 21.5%, zone 3: 17.6%) and survival rates (hemiarch: 66%, zone 1: 60.3%, zone 2: 68.0%, zone 3: 66.1%) were similar across all groups.
  • Aortic arch, descending aorta, and abdominal aorta growth rates did not differ significantly among the groups over 10 years.

Conclusions:

  • Hemiarch, zone 1, zone 2, and zone 3 aortic arch replacement yield comparable long-term survival and distal aorta growth in ATAAD patients.
  • Reoperation rates for distal aortic aneurysm were also similar across the different arch repair extents.
  • Individualized surgical strategies for aortic arch repair in ATAAD are supported, moving away from a one-size-fits-all aggressive approach.
Abstract

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