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Outcomes of ascending aorta and partial arch replacement with entry resection for DeBakey type I acute aortic dissection

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Abstract

Objectives

This study investigated early and late outcomes between ascending aorta/partial arch replacement and total arch replacement with entry resection in DeBakey type I acute aortic dissection (DIAAD) repair.

Methods and results

This study included 98 patients who underwent DIAAD repair from January 2005 to December 2020. Seventy-four patients underwent ascending aorta and partial arch replacement with entry resection (Non-TAR group), and 24 underwent total arch replacement with entry resection (TAR group). The mean follow-up period was 4.8 ± 3.2 years. The follow-up rate was 92.3%. The mean age in the Non-TAR and TAR groups was 68.8 ± 10.4 years and 61.6 ± 13.7 years, respectively (P = 0.046). No difference in preoperative shock and malperfusion syndrome was observed between the groups. Hospital death was observed in 5.4% and 12.5% of the Non-TAR and TAR groups, respectively (P = 0.241). Postoperative permanent neurologic deficits and temporary hemodialysis were more frequently seen in the TAR compared to the Non-TAR group (P = 0.03 and 0.003, respectively). The 5-year survival rates were 95.1% ± 3.4% and 89.2% ± 7.2% in the Non-TAR and TAR groups, respectively (Log-rank P = 0.603). Freedom from downstream aorta-related reinterventions at 5 years was 87.8% ± 4.5% and 64.1% ± 11.0% in the Non-TAR and TAR groups, respectively (Log-rank P = 0.007). Three patients in each group underwent thoracic endovascular aortic repair for residual aortic dissection.

Conclusions

Early and late outcomes in the Non-TAR group were satisfactory compared to those in the TAR group. Entry resection with graft replacement remains a standard approach in DIAAD repair.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Authors and Affiliations

  1. Department of Cardiovascular Surgery, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77, Higashinaniwa-cho, Amagasaki, Hyogo, 660-8550, Japan

    Naoto Fukunaga, Tatsuto Wakami, Akio Shimoji, Toshi Maeda, Otohime Mori, Kosuke Yoshizawa & Nobushige Tamura

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  1. Naoto Fukunaga
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  2. Tatsuto Wakami
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  7. Nobushige Tamura
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Correspondence to Naoto Fukunaga.

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Institutional review board approved this study (No. 4-76), and consent forms were waived.

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Fukunaga, N., Wakami, T., Shimoji, A. et al. Outcomes of ascending aorta and partial arch replacement with entry resection for DeBakey type I acute aortic dissection. Gen Thorac Cardiovasc Surg 72, 216–224 (2024). https://doi.org/10.1007/s11748-023-01966-z

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