Is hemiarch replacement adequate in acute type A aortic dissection repair in patients with arch branch vessel dissection without cerebral malperfusion?
Read at the 100th Annual Meeting of The American Association for Thoracic Surgery: A Virtual Learning Experience, May 22-23, 2020.
The study objective was to determine if hemiarch replacement is an adequate arch management strategy for patients with acute type A aortic dissection and arch branch vessel dissection but no cerebral malperfusion.
Methods
From January 2008 to August 2019, 479 patients underwent open acute type A aortic dissection repair. After excluding those with aggressive arch replacement (n = 168), cerebral malperfusion syndrome (n = 34), and indeterminable arch branch vessel dissection (n = 1), 276 patients with an acute type A aortic dissection without cerebral malperfusion syndrome who underwent hemiarch replacement comprised this study. Patients were then divided into those with arch branch vessel dissection (n = 133) and those with no arch branch vessel dissection (n = 143).
Results
The median age of the entire cohort was 62 years, with the arch branch vessel dissection group being younger (60 vs 62 years, P = .048). Both groups had similar aortic arch and descending thoracic aortic diameters, with significantly more DeBakey type I dissections (100% vs 80%) in the arch branch vessel dissection group. The arch branch vessel dissection group had more aortic root replacement (36% vs 27%, P = .0035) and longer aortic crossclamp times (153 vs 128 minutes, P = .007). Postoperative outcomes were similar between the arch branch vessel dissection and no arch branch vessel dissection groups, including stroke (10% vs 5%, P = .12) and operative morality (7% vs 5%, P = .51). The arch branch vessel dissection group had a significantly greater cumulative incidence of reoperation (8-year: 19% vs 4%, P = .04) with a hazard ratio of 2.89 (95% confidence interval, 1.01-8.27; P = .048), which was similar between groups among only DeBakey type I dissections (8-year: 19% vs 5%, P = .11). The 8-year survival was similar between the arch branch vessel dissection and no arch branch vessel dissection groups (76% vs 74%, P = .30).
Conclusions
Hemiarch replacement was adequate for patients with acute type A aortic dissection with arch branch vessel dissection without cerebral malperfusion syndrome, but carried a higher risk of late reoperation.
Graphical abstract
Key Words
acute aortic dissection
aortic arch management
arch branch vessel dissection
Abbreviations and Acronyms
ABVD
arch branch vessel dissection
ATAAD
acute type A aortic dissection
CI
confidence interval
CT
computed tomography
HR
hazard ratio
LCC
left common carotid
MPS
malperfusion syndrome
OR
odds ratio
Cited by (0)
B.Y. is supported by the National Heart, Lung, and Blood Institute of National Institutes of HealthK08HL130614, R01HL141891, and R01HL151776, the Phil Jenkins and Darlene & Stephen J. Szatmari Funds.
Date and Number of Institutional Review Board Approval: September 26, 2016, and HUM00119716.