Impact of an aggressive surgical approach on surgical outcome in type a aortic dissection

Total Arch Replacement Versus More Conservative Management in Type A Acute Aortic Dissection

“…In TAR patients, freedom from aortic re-intervention at 5 and 7 years was 84% and 72%, respectively, and was 87% and 85%, respectively, in CAM patients (log-rank p ¼ 0.3). Our long-term data are consistent with some already reported by others [20,24,25] and eventually confirm that the successful resection of the primary intimal tear and a thoughtful patient selection for different arch interventions may eventually equal long-term mortality and freedom from re-intervention after TAR and CAM.…”

“…For this reason, several groups have advocated the use of more aggressive primary operations in TAAD patients, including total arch replacement with or without elephant trunk construction [2,3] or, more recently, using the frozen elephant trunk technique [17][18][19]. Compared with CAM, TAR with classic or frozen elephant trunks may also facilitate and improve outcomes after secondary distal endovascular or open surgical interventions [20][21][22]. However, while some studies have reported a reduced patent false lumen incidence to almost 25% in patients undergoing TAR [20][21][22] and a recent review has shown that aortic remodeling is highly expected after TAR plus FET, as indicated by an 88.9% averaged rate of partial or complete thrombosis of the peri-stent false lumen [8], other studies have shown stable dissection evolutions with very low growth rates independent of the status of false lumen at the descending thoracic aorta, and with low rates of distal reinterventions at 10 years (<16%) [5,22,23].…”

Computational Analysis of the Mechanical Behaviors of Hemiarch and Total Arch Replacements

“…8,10,[20][21][22] We speculate that in these two procedures, HAR and TAR, the aortic arch is replaced to different extents using a woven polyester graft, and their different mechanical properties may contribute to the different results. In this study, the peak wall stress at the distal residual aorta was significantly higher after HAR than after TAR.…”

“…A number of reports have shown that an extensive TAR significantly reduces the incidence of a patent false lumen; enhances aortic remodeling, and may improve long-term outcomes for patients with acute type A aortic dissection. 8,10,[20][21][22] We assume that the favorable results of TAR relative to those of HAR can be attributed to its beneficial mechanical effect on the aorta. This study investigates the mechanical behavior of the aorta after HAR or TAR using a computational aortic model.…”

Results of Aortic Surgery in Patients with Marfan Syndrome

“…Kazui et al advocated an aggressive surgical approach for patients with Marfan syndrome. 23 We performed concomitant replacement of the aortic arch for selected patients with annuloaortic ectasia and DeBakey type I aortic dissection to avoid the risk of reoperation on the aortic arch.…”