Closing of a Patent Tear Above the Aortic Hiatus and Type A Aortic Dissection Outcomes

Abstract

BackgroundA strategy combining tear-oriented initial surgical procedure and subsequent thoracic endovascular aortic repair (TEVAR) can be adopted for acute type A aortic dissection (ATAAD). This study investigated this strategy’s outcomes and the role of the aortic hiatus (AH). MethodsOverall, 192 consecutive patients with ATAAD who underwent initial surgery between 2012 and 2021 were assessed in this observational retrospective study. The reintervention rate, the relationship of the residual tear location above or below the AH, and the outcomes of subsequent TEVAR and redo distal open repair were assessed. ResultsThe initial surgery’s in-hospital death rate was 8.3%; the subsequent TEVAR and redo distal open repair rates were 28% and 3%, respectively. Reintervention was performed in 93% and 0% of patients with tears above and below the AH, respectively, with a 0% mortality rate. ConclusionsIn false lumen expansion cases, timely detection and closure of the residual intimal tear above the AH with subsequent TEVAR might improve ATAAD outcomes.