Proximal and extended aortic arch replacement in acute DeBakey type I aortic dissection

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Aortic Dissection

Background:

• Acute DeBakey type I aortic dissection requires complex surgical intervention.
• Treatment strategies range from proximal repair to extensive aortic arch replacement.

Purpose of the Study:

• To compare short- and long-term outcomes of proximal repair versus extensive arch surgery for acute DeBakey type I aortic dissection.
• To evaluate the efficacy of limited aortic resection in managing this condition.

Main Methods:

• Retrospective analysis of 92 patients with acute type A dissection extending beyond the ascending aorta.
• Patients were divided into two groups: proximal repair (n=58) and extended repair (n=34).
• Perioperative variables and early/late postoperative results, including survival and reintervention rates, were analyzed.

Main Results:

• Proximal repair group had significantly shorter surgery, cardiopulmonary bypass, and circulatory arrest times (p<0.01).
• Operative mortality was 10.3% for proximal repair and 14.7% for extended repair (p=0.379).
• At 5-year follow-up, cumulative survival was 66.4% (proximal) vs. 76.1% (extended), and freedom from reintervention was 92.9% (proximal) vs. 72.6% (extended), with no significant differences (p=0.515 and p=0.134, respectively).

Conclusions:

• No significant differences in long-term cumulative survival or freedom from aortic reintervention were observed between proximal and extended aortic arch surgery.
• Limited aortic resection, as performed in proximal repair, achieves acceptable patient outcomes for acute DeBakey type I aortic dissection.