Safety and feasibility of aortic crossclamp for thrombosed acute type A aortic dissection

Aortic crossclamping in acute type A aortic dissection surgery facilitates proximal procedures during systemic cooling and reduces cardiopulmonary bypass time. However, concerns exist about embolization risk when crossclamping patients with thrombosed false lumen. We compared safety and feasibility of ascending aortic crossclamping between thrombosed and patent false lumen in acute type A aortic dissection.

This single-center retrospective study analyzed 1550 consecutive acute type A aortic dissection patients undergoing surgery between January 2004 and December 2023. Of these, 1407 patients completed aortic crossclamping and were divided into thrombosed false lumen (400 patients [28.4%]) and patent false lumen (1007 patients [71.6%]) groups. Propensity score matching yielded 400 matched pairs.

After propensity score matching, both groups showed similar preoperative characteristics. No significant differences existed in new onset ischemic stroke (5.8% vs 5.5%; P > .99) or spinal cord injury (1.3% vs 1.0%; P > .99). Thirty-day mortality was lower in the thrombosed false lumen group (2.3% vs 5.3%; P = .04). Sensitivity analyses adjusting for residual imbalances, including salvage surgery and redo surgery, confirmed consistent stroke safety (P = .64) and showed attenuated but directionally consistent mortality findings. Multivariate logistic regression revealed that a thrombosed false lumen was not an independent risk factor for new ischemic stroke (odds ratio, 1.04; 95% CI, 0.61-1.73; P = .88), but was protective for 30-day mortality (odds ratio, 0.47; 95% CI, 0.21-0.95; P = .047).

Ascending aortic crossclamping was safe and feasible in acute type A aortic dissection surgery regardless of false lumen status. Thrombosed false lumen presence does not increase neurological complications or early mortality risk.