Extended-arch repair for acute type-A aortic dissection: perioperative and mid-term results

• Published in: European journal of cardio-thoracic surgery 2019-10, Vol.56 (4), p.714-721
• Main Authors: Fichadiya, Akash, Gregory, Alexander J, Kotha, Vamshi K, Herget, Eric J, Smith, Holly N, Tai, Elizabeth, Guo, Ming, Mina, Fady, Appoo, Jehangir J
• Format: Article
• Language: English
• Subjects: Acute Disease; Adult; Aged; Aneurysm, Dissecting - classification; Aneurysm, Dissecting - surgery; Aorta, Thoracic - surgery; Aortic Aneurysm, Thoracic - surgery; Female; Humans; Male; Middle Aged; Retrospective Studies; Time Factors; Treatment Outcome; Vascular Surgical Procedures - methods
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1093/ejcts/ezz071

Abstract OBJECTIVES: Extended-arch techniques offer the potential to comprehensively treat acute type-A aortic dissection (ATAAD), but add surgical complexity compared to the standard hemiarch technique. This study describes both perioperative and mid-term outcomes following the introduction of an extended-arch technique for ATAAD. METHODS: Ours is a retrospective single-centre observational study of 95 consecutive patients with ATAAD from 2011 to 2016. The decision to perform extended-arch or hemiarch repair was individualized based on clinical and radiological features. Extended-arch repair was defined as replacement of the ascending aorta and arch with reimplantation of head vessels with or without distal endovascular extension. Clinical follow-up was 100% complete. Cross-sectional double-oblique measurements were performed for aortic remodelling analysis. RESULTS: Extended-arch (n = 28) and hemiarch (n = 67) repair resulted in a in-hospital mortality of 10% (n = 3) and 10%, (n = 7), and permanent neurological deficit rate of 7% and 12%, respectively. At a mean imaging follow-up duration of 2.7 ± 1.5 years, false lumen thrombosis was achieved in 57% and 9% of patients undergoing extended-arch and hemiarch repair, respectively. Rate of growth in the proximal descending aorta was 0.7 ± 2.3 mm/year in the extended-arch group vs 2.7 ± 3.9 mm/year in the hemiarch group. At a mean clinical follow-up time of 3.0 ± 1.6 years, open surgical aortic reoperation was 0% in the extended-arch group and 22% in the hemiarch group. CONCLUSIONS: Extended-arch repair of ATAAD can be introduced in the acute setting without increase in perioperative mortality or morbidity. At mid-term follow-up, extended-arch for ATAAD improves aortic remodelling and reduces the need for open surgical reoperation.