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Updated: Aug 2, 2025
Novel and Innovative Hybrid Technique for Type A Aortic Dissection
Published on: March 28, 2025
Hemiarch versus extended arch repair for acute type A dissection: Results from a multicenter national registry
Malak Elbatarny1, Louis-Mathieu Stevens2, Francois Dagenais3
1Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada; Division of Cardiac Surgery, Toronto General Hospital, Toronto, Ontario, Canada.
Insights
Extended arch repair for acute type A aortic dissection has similar mortality and neurologic risks as hemiarch repair. However, extended techniques carry a higher risk of adverse events and should be used cautiously.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Aortic Disease
Background:
- Acute type A aortic dissection (aTAAD) is a life-threatening condition requiring prompt surgical intervention.
- Surgical repair strategies for aTAAD involving the aortic arch vary, with hemiarch (HA) and extended arch (EA) repairs being common approaches.
- The optimal extent of aortic arch repair in aTAAD remains a subject of ongoing debate and research.
Purpose of the Study:
- To compare the perioperative outcomes of patients undergoing hemiarch (HA) versus extended arch (EA) repair for acute type A aortic dissection.
- To evaluate the impact of descending aortic intervention (EAD) versus no descending intervention (EAND) within the extended arch repair group.
- To identify risk factors associated with mortality, neurologic deficit, and composite adverse events in aTAAD repair.
Main Methods:
- A multi-center retrospective study involving 929 patients who underwent aTAAD repair between 2002 and 2021.
- Patients were categorized into hemiarch (HA) repair and extended arch (EA) repair groups, with EA further divided into those with descending aortic intervention (EAD) and without (EAND).
- Primary outcomes included in-hospital mortality, permanent neurologic deficit, computed tomography malperfusion resolution, and a composite of adverse events. Multivariable logistic regression was employed for analysis.
Main Results:
- In-hospital mortality (21% EA vs. 19% HA) and permanent neurologic deficit (18% EA vs. 17% HA) were similar between the EA and HA groups.
- Extended arch repair was not independently associated with an increased risk of death or neurologic deficit compared to hemiarch repair.
- Composite adverse events were significantly higher in the EA group (OR 1.47, P=0.001). Malperfusion resolution was more frequent after EAD (80%) compared to EAND (56%) and HA (50%) (P=0.004).
Conclusions:
- Extended arch repair for acute type A aortic dissection presents comparable perioperative mortality and neurologic risks to hemiarch repair.
- Descending aortic reinforcement techniques in EA repair may improve malperfusion resolution.
- Given the increased risk of composite adverse events, extended arch techniques should be approached with caution in the management of acute type A aortic dissection.
Objective:
We compared perioperative outcomes of patients with acute type A aortic dissection undergoing hemiarch (HA) versus extended arch (EA) repair with or without descending aortic intervention.
Methods:
Nine hundred twenty-nine patients underwent acute type A aortic dissection repair (2002-2021, 9 centers) including open distal repair (HA) with or without additional EA repair. EA with intervention on the descending aorta (EAD) included elephant trunk, antegrade thoracic endovascular aortic replacement, or uncovered dissection stent. EA with no descending intervention (EAND), included unstented suture-only methods. Primary outcomes were in-hospital mortality, permanent neurologic deficit, computed tomography malperfusion resolution, and a composite. Multivariable logistic regression was also performed.
Results:
Mean age was 66 ± 18 years, 30% (278 out of 929) were women, and HA was performed more frequently (75% [n = 695]) than EA (25% [n = 234]). EAD techniques included: dissection stent (39 out of 234 [17%]), thoracic endovascular aortic replacement (18 out of 234 [7.7%]), and elephant trunk (87 out of 234 [37%]). In-hospital mortality (EA: n = 49 [21%] and HA: n = 129 [19%]; P = .42), and neurological deficit (EA: n = 43 [18%] and HA: n = 121 [17%]; P = .74) were similar. EA was not independently associated with death (EA vs HA odds ratio, 1.09; 95% CI, 0.77-1.54; P = .63) or neurologic deficit (EA vs HA odds ratio, 0.85; 95% CI, 0.47-1.55; P = .59). Composite adverse events differed significantly (EA vs HA odds ratio, 1.47; 95% CI, 1.16-1.87; P = .001). Malperfusion resolved more frequently after EAD (EAD: n = 32 [80%], EAND: n = 18 [56%], HA: n = 71 [50%]; P = .004), although multivariable analysis was not significant (EAD vs HA odds ratio, 2.17; 95% CI, 0.83-5.66; P = .10).
Conclusions:
Extended arch interventions pose similar perioperative mortality and neurologic risks as Hemiarch. Descending aortic reinforcement may promote malperfusion restoration. Extended techniques should be approached with caution in acute dissection due to increased risk of adverse events.
