Total aortic arch replacement in acute type A aortic dissection - a single institutional experience.

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Aortic Surgery

Background:

• Total arch replacement is a challenging procedure, especially in acute aortic dissections.
• Outcomes data for total arch replacement in the Indian population are limited.
• This study addresses the need for localized outcome data in acute aortic dissection management.

Purpose of the Study:

• To assess the outcomes of total arch replacement in patients with acute aortic dissection.
• To evaluate the safety and efficacy of this procedure in a single tertiary care center in India.
• To provide data on morbidity and mortality associated with total arch replacement for acute aortic dissection.

Main Methods:

• A retrospective review of 20 patients who underwent total arch replacement for acute type A aortic dissection between 2012 and 2022.
• Exclusion of patients with hemi-arch repairs, hybrid repairs, or aneurysmal disease.
• Analysis of demographic, intraoperative, and postoperative data, comparing survivors and non-survivors.

Main Results:

• The study included 20 patients (75% male, mean age 49.3 years) undergoing total aortic arch replacement.
• In-hospital mortality was 20% (4 patients), with a 30% re-exploration rate.
• Neurological complications included 5% permanent stroke and 5% temporary neurological dysfunction; overall mean survival was 76.1 months.

Conclusions:

• Total arch replacement can be performed with acceptable mortality and morbidity in acute aortic dissections.
• The findings support the feasibility of this complex procedure in the Indian healthcare setting.
• Further research with larger cohorts is warranted to refine surgical strategies and improve outcomes.