Abstract 16591: Surgical vs Non-surgical Repair of Aortic Arch in Type A Aortic Dissection: An Inverse Probability Treatment Weighting Propensity Score

Abstract

Introduction: Several surgical techniques are used in acute type A aortic dissection (TAAAD). Most are treated with hemiarch or limited replacement of the ascending aorta with interposition graft while total aortic arch replacement is less frequently performed. The research question/hypothesis: Is total arch replacement justified by the favourable late outcomes despite early complications? Aims: To evaluate if conservative approaches (root-sparing and hemiarch) can improve the early and late outcomes compared to total arch replacement. Methods: From 2005 and 2021, 633 patients underwent TAAAD repair of which 192(30.0%) were women. The ascending aorta replacement with/without root-sparing (group 1) were compared to the partial or total arch replacement cohort (group 2) using propensity score matching. A regression model with inverse probability treatment weighting by propensity score (IPTW) was built to generate a weighted cohort. Results: Patients undergoing aortic arch surgery were significantly younger (mean age 61.0 vs 66.5years; p<0.001), frequently male (70%) or with a family history of aortic dissection or aneurysm (P=0.005). Antegrade cerebral perfusion was preferred when arch surgery was performed (83.5% vs33.8%, P<0.001). Post-IPTW by propensity score analysis revealed that aortic arch surgery was associated with thirty-day mortality (odds ratio 1.60; 95% CI, 1.00-2.55, p=0.05), postoperative stroke (odds ratio 2.19; 95% CI, 1.29-3.73, P=0.004), postoperative sepsis (odds ratio 1.76; 95% CI,1.08-2.87, P=0.02) and mid-term mortality (hazard ratio 1.44, 95% CI, 1.05-1.99, p=0.03). Conclusions: A tailored approach deploying ascending aorta replacement with or without root-sparing in TAAAD prompted to useful outcomes without compromising durability.