• J. Am. Coll. Surg. · Jan 2025

    Simple vs Complex Aortic Arch Repair in Acute Type A Aortic Dissection.

    • Jordyn Pendarvis, Omar M Sharaf, Ahmet Bilgili, Zhihua Jiang, Jaden A Jeng, Daniel S Demos, John R Spratt, Phillip Hess, Thomas M Beaver, Gilbert R Upchurch, Tomas D Martin, and Eric I Jeng.
    • University of Florida Health, Division of Cardiovascular Surgery, Department of Surgery, Gainesville, Florida USA.
    • J. Am. Coll. Surg. 2025 Jan 27.

    BackgroundThe purpose of this study is to evaluate the clinical outcomes of patients undergoing a simpler (hemiarch) vs complex (zone 2 arch) aortic repair for acute type A aortic dissection (TAAD).MethodsAdults (≥18 years) who underwent hemiarch or zone 2 arch repair for acute, hyperacute, or acute on chronic TAAD at a single institution between January 2018 and April 2024 were reviewed. Disabling stroke was defined as modified Rankin scale ≥4. Statistical analysis included univariate comparisons, Kaplan-Meier analysis, and multivariable modeling.ResultsTwo hundred eighty-three acute TAAD patients underwent hemiarch (44.5%, n=126) and/or zone 2 arch (55.5%, n=157) repair. Hemiarch patients were older (63.3±14.1 vs 56.3±12.2 years, P<0.001), but had lower rates of preoperative cerebrovascular disease (11.1%[n=14] vs 21.7%[n=34], P=0.03), chronic kidney disease (16.7%[n=21] vs 33.1%[n=52], P=0.003), and previous sternotomy (13.5%[n=17] vs 35.0%[n=55], P<0.001). Cardiopulmonary bypass and cross clamp times were shorter in hemiarch patients (214±78.5 vs 261±62.3 minutes, P<0.001; 135±54.4 vs 182±60.0 minutes, P<0.001, respectively). Postoperatively, there was no difference in the rate of disabling stroke (4.5%[n=13], P=0.12), tracheostomy (14.8%[n=43], P=0.15), pneumonia (17.2%[n=50], P=0.24), or renal failure requiring permanent dialysis (6.2%[n=18], P=0.47). In multivariable analysis, older age (HR 1.05, 95% CI=1.02-1.08) was a risk factor for longitudinal mortality, while complex aortic arch repair did not confer increased risk (HR 0.68, 95% CI=0.35-1.31).ConclusionsComplex aortic arch reconstruction provides a framework for down-stream endovascular procedures for the remaining aorta and can be performed in acute TAAD without increased risk of morbidity or mortality compared with a simpler repair.Copyright © 2025 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.

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