Is Total Arch Replacement Associated With Worse Outcomes During Repair of Acute Type A Aortic Dissection?
BACKGROUND
As acute type A aortic dissection (ATAAD) remains a challenge, the extent of resection of the transverse arch remains debated during operative repair. The purpose of this study was to compare the outcomes of total arch repair versus ascending/proximal arch repair for ATAAD.


METHODS
We retrospectively reviewed our aortic database of ATAAD between October 1999 and December 2014. Patients were divided into two groups: total arch repair versus proximal arch repair (hemiarch). Indications for arch replacement during ATAAD include aneurysm greater than 5 cm, complex arch tear, and arch rupture. Inhospital and long-term outcomes were compared between the two groups using univariate analysis and multiple logistic regression analysis. Survival was analyzed using Kaplan-Meier and log rank statistics, and assessment of risk factors for survival was conducted by Cox proportional hazards regression analysis.


RESULTS
During the study period, we performed 489 repairs of ATAAD, 49 patients (10%) with total arch replacement and 440 patients (90%) with proximal arch replacement. Patients with total arch repair were older (62.4 ± 13.4 years versus 57.9 ± 14.8 years, p = 0.046) and had significantly increased retrograde aortic dissection, circulatory arrest, and retrograde cerebral perfusion times. The incidences of early mortality, stroke, and need for renal dialysis between the total arch and proximal arch group were not significantly different: 20.4% (10 of 49) versus 12.9% (57 of 440), 8.2% (4 of 49) versus 10.5% (46 of 440), and 27% (13 of 49) versus 17.6% (76 of 432), respectively. Late survival did not demonstrate a difference between groups.


CONCLUSIONS
Acute type A aortic dissection remains a challenge associated with significant mortality and morbidity. When compared with a less aggressive resection, total arch replacement performed in an individualized fashion can be associated with acceptable early and late outcomes for ATAAD and was not associated with worse outcomes.
University of Texas Medical School at Houston, Memorial Hermann Heart and Vascular Institute, Houston, Texas.
Robert D
RD
Rice
University of Texas Medical School at Houston, Memorial Hermann Heart and Vascular Institute, Houston, Texas.
Harleen K
HK
Sandhu
University of Texas Medical School at Houston, Memorial Hermann Heart and Vascular Institute, Houston, Texas.
Samuel S
SS
Leake
University of Texas Medical School at Houston, Memorial Hermann Heart and Vascular Institute, Houston, Texas.
Rana O
RO
Afifi
University of Texas Medical School at Houston, Memorial Hermann Heart and Vascular Institute, Houston, Texas.
Ali
A
Azizzadeh
University of Texas Medical School at Houston, Memorial Hermann Heart and Vascular Institute, Houston, Texas.
Kristofer M
KM
Charlton-Ouw
University of Texas Medical School at Houston, Memorial Hermann Heart and Vascular Institute, Houston, Texas.
Tom C
TC
Nguyen
University of Texas Medical School at Houston, Memorial Hermann Heart and Vascular Institute, Houston, Texas.
Charles C
CC
Miller
University of Texas Medical School at Houston, Memorial Hermann Heart and Vascular Institute, Houston, Texas.
Hazim J
HJ
Safi
University of Texas Medical School at Houston, Memorial Hermann Heart and Vascular Institute, Houston, Texas. Electronic address: anthony.l.estera@uth.tmc.edu.
Anthony L
AL
Estrera
D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000150:complications / Q000401:mortality / Q000601:surgery*; D001014:Aortic Aneurysm / Q000150:complications / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D016896:Treatment Outcome