Long-term outcomes of tear-oriented ascending/hemiarch replacements for acute type A aortic dissection.

Abstract

Extended arch repair for acute type A aortic dissection remains controversial. Our strategy for acute type A aortic dissection was primary entry resection and tear-oriented ascending/hemiarch replacement for patients with the intimal tear in the ascending aorta or is not found in the ascending/aortic arch. Extended total/partial arch replacement was performed for patients with the tear located in the aortic arch. Here, we investigated the validity of our strategy from the viewpoints of long-term survival and reoperation. Between 2003 and 2014, 267 acute type A aortic dissection patients (mean age; 65.2±12.9years, 134 men and 133 women) underwent emergent surgical repair. Ascending/hemiarch replacements were performed in 225 patients (ascending/hemiarch group) and total/partial arch replacements in 42 patients (arch group). Early and late outcomes of both groups were compared. The hospital mortality rates in the ascending/hemiarch and the arch groups were 4.4 and 9.5%, respectively (p=0.25). For ascending/hemiarch and arch groups, the actuarial survival rates were 80.7 vs. 84.3% after 5years, and 66.4 vs. 74.6%, respectively, after 10years (p=0.94). For ascending/hemiarch and arch groups, reoperation-free survival rates were 72.1 vs. 77.1% after 5years, and 62.0 vs. 67.1%, respectively, after 10years (p=0.85). We observed no significant differences in the actuarial survival or reoperation-free survival rates between the groups. These findings suggest that tear-oriented ascending/hemiarch replacement for acute type A aortic dissection does not increase the risk of long-term mortality or reoperation.