Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Oct;162(4):1025-1031.
doi: 10.1016/j.jtcvs.2020.02.087. Epub 2020 Mar 7.

Results of ascending aortic and arch replacement for type A aortic dissection

Keiji Uchida  1 , Tomoyuki Minami  2 , Tomoki Cho  2 , Shota Yasuda  2 , Keiichiro Kasama  2 , Shinichi Suzuki  2 , Munetaka Masuda  2 ; Yokohama City University CVS Group  2
Collaborators, Affiliations
Free article

Results of ascending aortic and arch replacement for type A aortic dissection

Keiji Uchida et al. J Thorac Cardiovasc Surg. 2021 Oct.
Free article

Abstract

Objective: The outcomes of emergency surgery for type A acute aortic dissection have improved. However, ascending aortic replacement sometimes leads to dilatation of the distal aorta. The present study reviewed our outcomes of ascending aortic replacement and total arch replacement in patients with type A acute aortic dissection.

Methods: A total of 253 patients with type A acute aortic dissection underwent a central repair operation. Our standard technique was ascending aortic replacement. Total arch replacement was performed only when entry existed in the major curvature of the aortic arch and the proximal descending aorta. A total of 169 patients (67%) underwent ascending aortic replacement, and 84 patients (33%) underwent total arch replacement. Hospital death due to initial surgery, dilatation of the distal aorta greater than 5 cm, new occurrence of aortic dissection, any distal aortic surgery, and aortic-related deaths were defined as distal aortic events.

Results: The mortality was 7.1% in the ascending aortic replacement group and 6.0% in the total arch replacement group. Postoperative computed tomography was performed in 162 patients in the ascending aortic replacement group. The false lumen of the residual aortic arch had thrombosed and healed in 94 patients (58%) and remained present in 68 patients (42%). The distal aortic event-free rate in the ascending aortic replacement group decreased from 74% at 5 years to 51% at 9 years, and the rate in the total arch replacement group was 83% at 5 to 9 years (P < .01). For the ascending aortic replacement group, more patients with a dissected arch had a distal aortic event compared with patients with a healed arch (P < .01).

Conclusions: Total arch replacement was associated with fewer distal aortic events. We may expand the indications for total arch replacement in stable patients.

Keywords: ascending aortic replacement; distal aortic event; total arch replacement; type A acute aortic dissection.

PubMed Disclaimer

Comment in

MeSH terms