title: Total arch repair versus hemiarch repair in the management of acute DeBakey type I aortic dissection.
abstract: OBJECTIVE
  In acute DeBakey type I aortic dissection, it is still controversial whether to perform extended aortic replacement to improve long-term outcome or to use a conservative strategy with ascending aortic and hemiarch replacement to palliate a life-threatening condition.
  
  
  METHODS
  Between 1999 and 2009, 188 consecutive patients (93 women; mean age, 57.4±11.7 years) with acute DeBakey type I aortic dissection underwent hemiarch (Hemiarch group; n=144) or total arch replacement (Total arch group; n=44) in conjunction with ascending aorta replacement. Clinical outcomes were compared after adjustment for baseline characteristics using inverse-probability-of-treatment weighting.
  
  
  RESULTS
  Median follow-up was 47.5 months (range 0-130.4 months) and was 92.0% (n=173) complete. Five-year unadjusted survival and permanent-neurologic-injury-free survival rates were 65.8±8.3% and 43.1±9.7% in the Total arch group, and 83.2±3.3% and 75.2±4.0% in the Hemiarch group, respectively (P=0.013 and <0.001). After adjustment, the Total arch group patients were at greater risks of death (hazard ratio (HR) 2.38, 95% confidence interval (CI) 1.21-4.67; P=0.012), and permanent neurologic injury (HR 3.25, 95% CI 1.31-8.04; P=0.011) compared to the Hemiarch group patients. The risks of the re-operation for aortic pathology or distal aortic dilatation (>55 mm) were similar for both groups (HR 0.33, 95% CI 0.08-1.43; P=0.14).
  
  
  CONCLUSIONS
  Total arch repair was associated with greater morbidity and mortality compared with hemiarch repair in acute DeBakey type I aortic dissection. Rates of aortic re-operation or aortic dilatation were not significantly different between the two surgical strategies. These findings support a conservative surgical approach to circumvent this life-threatening situation.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
authors.forename: Joon Bum
authors.initials: JB
authors.lastname: Kim
authors.forename: Cheol Hyun
authors.initials: CH
authors.lastname: Chung
authors.forename: Duk Hwan
authors.initials: DH
authors.lastname: Moon
authors.forename: Geong Jun
authors.initials: GJ
authors.lastname: Ha
authors.forename: Taek Yeon
authors.initials: TY
authors.lastname: Lee
authors.forename: Sung Ho
authors.initials: SH
authors.lastname: Jung
authors.forename: Suk Jung
authors.initials: SJ
authors.lastname: Choo
authors.forename: Jae Won
authors.initials: JW
authors.lastname: Lee
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000601:surgery*; D001011:Aorta / Q000601:surgery; D001013:Aorta, Thoracic / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D016896:Treatment Outcome