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
. 2022 Dec;37(12):4267-4268.
doi: 10.1111/jocs.16916. Epub 2022 Sep 10.

Total arch replacement versus proximal aortic replacement in acute type A aortic dissection: Aggressive versus conservative

Matti Jubouri  1 , Daniyal Matin Ansari  2 , Feras Zaqout  3 , Mohamad Bashir  4 , Mohammed Idhrees  5
Affiliations

Total arch replacement versus proximal aortic replacement in acute type A aortic dissection: Aggressive versus conservative

Matti Jubouri et al. J Card Surg. 2022 Dec.

Abstract

Background: Acute type A aortic dissection (ATAAD) is a life-threatening medical condition requiring urgent surgical attention. It is estimated that 50% of ATAAD die within 24 h of onset, with the mortality rate is increasing by 1%-2% every additional hour without prompt intervention. A variety of ATAAD surgical repair techniques exist which has sparked controversy within the literature, with the main two strategies being proximal aortic replacement (PAR) and total arch replacement (TAR). Nevertheless, the question of which of these two strategies if the more optimal is still debatable.

Aims: This commentary aims to discuss the recent study by Sa and colleagues which presents a pooled analysis of Kaplan-Meier-derived individual patient data from studies with follow-up comparing aggressive (TAR) and conservative (PAR) approaches to manage ATAAD patients.

Methods: A comprehensive literature search was performed using multiple electronic databases including PubMed, Ovid, Google Scholar, EMBASE, and Scopus to collate the relevant research evidence.

Results: The more aggressive TAR approach for treating ATAAD seems to yield more favorable results including more optimal long-term survival as well as a lower need for reoperation. The frozen elephant trunk (FET) technique can be considered the mainstay TAR technique.

Conclusion: It is valid to conclude that TAR with FET is the superior strategy for managing ATAAD patients.

Keywords: acute type A aortic dissection (ATAAD); aortic arch; frozen elephant trunk (FET); hemiarch; proximal arch repair (PAR); total arch repair (TAR).

PubMed Disclaimer

References

REFERENCES

    1. Kuang J, Yang J, Wang Q, Yu C, Li Y, Fan R. A preoperative mortality risk assessment model for Stanford type A acute aortic dissection. BMC Cardiovasc Disord. 2020;20(1):508.
    1. Sa M, Jacquemyn X, Tasoudis P, et al. Long-term outcomes of total arch replacement versus proximal aortic replacement in acute type A aortic dissection: meta-analysis of Kaplan-Meier-derived individual patient data. J Card Surg. Forthcoming 2022. doi:10.1111/jocs.16852
    1. Vendramin I, Piani D, Lechiancole A, et al. Hemiarch versus arch replacement in acute type A aortic dissection: is the Occam's razor principle applicable? J Clin Med. 2021;11(1):114.
    1. Ok YJ, Kang SR, Kim HJ, Kim JB, Choo SJ. Comparative outcomes of total arch versus hemiarch repair in acute DeBakey type I aortic dissection: the impact of 21 years of experience. Eur J Cardiothorac Surg. 2021;60(4):967-975.
    1. Uchida K, Minami T, Cho T, et al. Results of ascending aortic and arch replacement for type A aortic dissection. J Thorac Cardiovasc Surg. 2021;162(4):1025-1031.

LinkOut - more resources