The 20-year outcome of ascending aorta replacement and total arch replacement comparison in DeBakey type I acute...

The mortality rate of acute DeBakey type I aortic dissection increases by 1%-2% every hour after the first presentation if left untreated. However, the long-term outcomes of ascending aorta replacement (AR) versus total arch replacement (TAR) remain unclear. This study evaluated and compared the long-term outcomes between AR and TAR.

This retrospective study included 398 patients with acute DeBakey type I aortic dissection who underwent surgical repair between March 2002 and October 2024. Patient data were extracted from medical records, and patients were stratified into two groups (AR and TAR groups) according to the surgical procedure. Inverse probability of treatment weighting was applied for further analysis.

Higher incidences of acute kidney injury (32.3% vs 20.6%, P = 0.029), new-onset stroke (9.5% vs 3.7%, P = 0.016), and bleeding (30.1% vs 16.2%, P = 0.007) and longer hospital stays (34.4 vs 25.7 days, P = 0.042) were observed in the TAR group than in the AR group immediately postoperation. In long-term follow-up, no significant differences were observed between the groups regarding reintervention or mortality events. In addition, the risk of relative mortality associated with TAR was more apparent in patients older than 65 years.

No significant differences were observed between TAR and AR in terms of 30-day mortality, reintervention events, aorta-related mortality, or overall mortality under the tear-oriented policy for acute DeBakey type I aortic dissection. Notably, older patients undergoing TAR had poorer overall survival outcomes than did those undergoing AR, particularly among patients older than 65 years.