Extended versus limited arch replacement in acute Type A aortic dissection

Abstract

Selective, or 'surgeon's choice', extended arch replacement had no discernible acute downside compared with less extensive surgery. Whether extended arch replacement improves the prognosis beyond 5 years remains to be settled.

Surgical Outcomes of Type A Aortic Dissection at a Small- Volume Medical Center: Analysis according to the Extent of Surgery

“…In addition, the early mortality rate in A number of studies have explored the extent to which the aortic annulus or arch should be included in surgical treatment [12][13][14]. The TAR ratio was 16.3% in our study, which is similar to that in previous studies [9][10][11]. The protocol in our center has not changed over the past decade, and we only performed TAR in cases of arch aneurysms or arch tears.…”

“…In our study, the 30-day mortality rate was 8.2%, which was determined to be acceptable when compared to previous studies [9][10][11]. There was no statistically significant difference between the limited replacement group and the TAR group (6.1% and 18.8%, respectively), but the TAR group had a higher 30-day mortality rate.…”

Characteristics and Surgical Results of Acute Type A Aortic Dissection in Patients Younger Than 50 Years of Age

“…The rate of TAR was equal or higher than that in previous reports (15%-48%). 1,2,[13][14][15][16] However, whether extensive aortic replacement should be performed in the emergency setting still remains controversial. Di Eusanio et al reported that TAR is one of the independent risk factors for in-hospital mortality on the basis of the complete International Registry of Aortic Dissection (IRAD) database (1,995 surgery patients from January 1996 to January 2013).…”

“…13) Another report of the IRAD database identified that early and mid-term results between patients who underwent hemiarch replacement and those who underwent extensive TAR had no significant differences in a propensity score-adjusted multivariable analysis (1,241 patients from March 1996 to March 2015). 14) On an analysis of the GERAADA data, Easo et al reported that the aggressive approach of TAR can be performed in patients with AAAD at an acceptable operative risk compared with the standard treatment with the replacement of the ascending aorta. 15) However, they also reported that a subgroup analysis without a preexisting neurologic deficit demonstrates a high mortality for patients treated with TAR.…”

Extended Arch Procedures for Acute Type A Aortic Dissection: A Downstream Problem?

“…16 Early Mortality and Late Events: Hemiarch vs Extended Procedures While many experienced centers reported no difference in early mortality between proximal repair and extended repair, 1,2,16À18 the German Registry for Acute Aortic Dissection Type A (GER-AADA) and International Registry of Acute Aortic Dissections (IRAD) registries showed a trend 19,20 and a meta-analysis of 1872 patients from 9 studies showed significantly less early mortality with proximal repair. 21 Regarding long-term survival, although some studies have shown improved survival with extended repair, 17 most, 1,16,18 including the IRAD 20 and metaanalysis 21 reports show no difference in late survival between proximal repair and extended repair approaches. In terms of late events, Omura and colleagues 1 and the meta-analysis by Yan 21 and colleagues report a significant increase in late events with proximal repair.…”