The following is a summary of “Tailored approach and outcomes of aortic arch reconstruction after acute type A dissection repair” published in the October 2023 issue of Thoracic and Cardiovascular Surgery by Vekstein, et al.
Around 20% to 30% of patients will need distal reintervention, most often for arch pathology, after restricted root/ascending treatment for acute type A aortic dissection (ATAAD). This treatment may or may not include hemiarch repair. In this paper, The researchers explain both the operative and long-term results of arch care after prior limited ATAAD repair and present an institutional algorithm for the management of arches. From August 2005 until April 2021, 71 patients who had previously undergone limited ATAAD repair underwent reoperative arch repair involving zones 1 to 3 for aneurysmal degeneration of residual arch dissection.
This included complete cervical debranching with zone 0/1 thoracic endovascular aortic repair in 6 (8%), open total arch in 13 (18%), type I hybrid arch repair in 23 (32%) and type II/III hybrid arch repair in 29 (41%) of the patients.
The median age was 59 years old, and the median amount of time that had passed after the index ATAAD repair before the subsequent procedure was 4 years (interquartile range: 2–9). Within the first 30 days after surgery, there were two fatalities that occurred in the hospital (2.8%) and two deaths that occurred after discharge (2.8%). Around 4.5% of patients had a stroke, and two and a half percent of patients experienced acute renal failure that required dialysis.
According to Kaplan and Meier, the overall survival rate was 78% after one year, 70% at three years, and 58% at five years. Because there have been no operative mortalities in the past 9 years and improved survival of 87% versus 66%, 79% versus 58%, and 79% versus 40% at 1, 3, and 5 years in comparisons of the past 9 years with the previous era (P =.01), it appeared that institutional experience played a significant role in early and late outcomes.