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Acute DeBakey Type I aortic dissection without intimal tear in the arch: is total arch replacement the right choice?

Abstract：

OBJECTIVES:Surgical management of acute DeBakey Type I aortic dissection without intimal tear in the aortic arch is controversial. This study compared short- and long-term outcomes of total arch replacement (TAR) versus limited ascending aorta/hemiarch replacement (no-TAR) in a consecutive series of patients. METHODS:Between January 1998 and December 2015, 220 consecutive patients were operated for DeBakey Type I acute aortic dissection; 135 cases did not exhibit an intimal entry tear in the aortic arch and were subsequently selected to comprise the primary study cohort. A secondary subgroup analysis was made within these 135 cases, which comprised patients who received antegrade cerebral perfusion as the neuroprotective strategy of choice (n = 45). RESULTS:Mean follow-up period was 5 ± 4 years. Among the patients selected, 21 (16%) underwent TAR. Thirty-day mortality was higher in the TAR group (38% vs 21%, P = 0.04). Postoperative complication rates were similar between the groups (61% vs 73%, P = 0.31). Long-term mortality and late aortic reintervention rates were also similar (7% vs 30%, P = 0.36 and 27% vs 14%, P = 0.32, respectively). From the subgroup of patients with antegrade cerebral perfusion, 14 (31%) underwent TAR and 31 (69%) had no-TAR. Mean follow-up-time was 3 ± 2 years. Thirty-day mortality was higher in the TAR group (50% vs 16%, P < 0.01), postoperative complications, long-term mortality and late aortic reintervention rates were similar (64% vs 69%, P = 0.73; 0% vs 19%, P = 0.22; 29% vs 8%, P = 0.17, respectively). CONCLUSIONS:TAR was associated with higher 30-day mortality compared with the less extensive hemiarch replacement. In the long term, TAR showed a trend of improved survival and higher reintervention rate.

journal_name

Interact Cardiovasc Thorac Surg

journal_title

Interactive cardiovascular and thoracic surgery

authors

Colli A,Carrozzini M,Francescato A,Galuppo M,Comisso M,Toto F,Gregori D,Gerosa G

doi

10.1093/icvts/ivx229

subject

Has Abstract

pub_date

2018-01-01 00:00:00

pages

84-90

issue

eissn

1569-9293

issn

1569-9285

pii

4056492

journal_volume

pub_type

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Acute DeBakey Type I aortic dissection without intimal tear in the arch: is total arch replacement the right choice?